IndicatorsandToolsfortheCostofNutritiousDietsAnnaHerforthandWilliamA.Masters15 June2019

http://sites.tufts.edu/candasa

Photo:AHerforth,Ghana,2016

CANDASATeam(2018-2020)

TuftsFriedmanSchool:WillMasters,PIAnnaHerforth,Co-InvestigatorYanBai,PhDstudentKateSchneider,PhDstudentHalliePerlick,ResearchAdministrator

IFPRI:DerekHeadey,Co-PIKalyani Raghunathan,IFPRI-IndiaFantu Bachewe,IFPRI-Ethiopia

UniversityofGhana:DanielSarpong

Sokoine UniversityofAgriculture,Tanzania:Fulgence Mishili

GovernmentofMalawi:Stevier Kaiyatsa

IANDATeam(2015-2017)

TuftsFriedmanSchool:AnnaHerforth,PIJenniferCoates,PIWilliamMasters,Co-InvestigatorYanBai,PhDstudentZacharyGersten,ResearchAdministrator

UniversityofGhana:DanielSarpong,ResearchEconomistMaryNanaAnimaAkrofi,ResearchAssistant

Sokoine UniversityofAgriculture,Tanzania:JoyceKinabo,ResearchNutritionistFulgence Mishili,ResearchEconomistHusseinHenryMvungi,ResearchAssistant

JohnsHopkinsBloombergSchoolofPublicHealth:RebeccaHeidkamp,ResearchNutritionist

IANDA:IndicatorsofAffordabilityofNutritiousDietsinAfrica(2015-17)

• Developedseveralnewmetrics:CostofRecommendedDiet(CoRD),CostofNutrientAdequacy(CoNA),andothers.

• Conductedalandscapeanalysisoffoodpricedatacollectionatnationalandgloballevels,interviewingstakeholdersinnationalandglobalinstitutionstounderstandtheirroleincollectinganddisseminatingfoodpriceinformation,andhowitisusedindecision-making.

• Engagedwithstakeholdersintwocountries,GhanaandTanzania,buildingmetricsusingtheirexistingdataandexploringintegrationofmetricsintotheirfoodpricemonitoringsystems.

CANDASA:ChangingAccesstoNutritiousDietsinAfricaandSouthAsia(2018-2020)

• RefiningandpublishingCoNAandCoRD methodologies.• Researchingthecostofnutrientadequacyand

recommendeddietsinIndia,Malawi,Ethiopia,Tanzania,Ghana,Myanmar;alsoexploringapplicationinothercountriessuchasNigeriaandNepal.

• Researchinghowaccesstonutritiousdietschangesbasedonshiftsovertimeandspaceinfoodprices,wages,andupstreamdeterminantssuchasinfrastructureandGDP.

• Researchinghowfoodpricesareassociatedwithdietandnutritionalstatus,wheredataareavailable.

• ContinuedcontactwithGhanagovernmentstakeholders,andestablishingagroupledbytheUniversityofGhanaInstituteforStatistical,Social&EconomicResearch(ISSER)tosupportintegratingthenewmetricsintoGhanafoodpricemonitoring.

Publications,uptake, andfuturework

• ArticlesincludeMastersetal.(2018),“MeasuringtheAffordabilityofNutritiousDietsinAfrica”inAm.J.ofAgric.Econ. 100(5):1285-1301.

• NewindicatorshavebeenusedbytheWorldBank,e.g.DizonandHerforth(2018)“TheCostofNutritiousFoodinSouthAsia”WorldBankPolicyResearchWorkingPaper.

• Weenvisionprovidingincreasedsupporttogovernmentsandglobalinstitutionstousecostofnutritiousdietmetricsinroutinefoodpricemonitoring,toshiftdialogueandfocustowardincentivizingavailabilityandaccesstonutritiousdiets.

Evolutionofnewmetricsforthecostofnutritiousdiets

Rationaleforthiswork:Existingindicatorsusedtomeasurechangeovertimeinthecostoffooddonotconsideritsnutritionalquality.Globalmetrics suchastheFAO’sFoodPriceIndexreflectquantitiestradedonworldmarkets,whileeachcountry’sConsumerPriceIndexreflectsquantitiescurrentlyconsumedbyitspopulation.Neitherreflectsthehealthydietspromotedbymanypoliciesandprograms.

Newindicatorsareneededtotrackdifferencesinaccesstonutritiousfoodsateachlocation,andtherebyguidesystemicchange andotherinterventionstobringhealthydietsmorecloselywithinreachforpeopleatriskofmalnutrition.Marketpriceindexesallowustoidentifywhatinterventionsmosteffectivelyimproveaffordabilityofhealthydiets,andtomeasuretheirimpactonnutritionoutcomes.

ChangingAccesstoNutritiousDietsinAfricaandSouthAsia(CANDASA)isan$800,000investmentover2.5years(December2017– June2020),jointlyfundedbytheUKDepartmentforInternationalDevelopmentandtheBill&MelindaGatesFoundation(BMGF),implementedbytheFriedmanSchoolofNutritionatTuftsUniversitywiththeInternationalFoodPolicyResearchInstitute(IFPRI)andotherresearchpartnersinIndia,Bangladesh,Ethiopia,Ghana,MalawiandTanzania.CANDASAbuildsdirectlyonapriorproject,IndicatorsofAffordabilityofNutritiousDietsinAfrica(IANDA)fundedbytheUKDepartmentforInternationalDevelopmentthroughanIMMANAgrant(2015-2017),andAdvancingResearchinAgriculture-NutritionActions(ARENA)atIFPRIfundedbyBMGF(2014-2020).

Theproject’sobjectiveistoanswerthefollowingquestions:1) Howdopricesandavailabilityofnutritiousfoodsanddietsvaryovertimeandspace,relativetowagesandotherearnings?2) Whenandwheredoesinvestmentinruralinfrastructureandfarmingsystemsimproveandstabilizeaccesstohealthydiets?3) Doesthevariationweseeinpriceandavailabilityofnutrient-richfoodshavesignificantassociationswithnutritionoutcomes?

Resultswillinformpoliciesandprogramsinourtargetcountries,andprovidegeneralizableresultstoguidenutrition-smartinvestmentselsewhere.

CostofNutrientAdequacy(CoNA)

Purpose:CoNAmeasurestheminimumcostofusinglocally-availablefoodstoobtainenoughofallessentialnutrientsneededforanactiveandhealthylife.Themeasurecanbeusedforadvocacy,designandevaluationofinterventions,aswellasresearchaboutthecausesandconsequencesofchangingfoodprices.

Methods:CoNAiscalculatedwithlinearprogrammingusingdataon(1)thepriceofeachlocally-availablefood,(2)itsnutrientcomposition,and(3)nutrientrequirementsintermsofbothlowerandupperlimits.Resultsbecomevaluableonlywhenaccuratepricesandnutrientcompositiondataareavailableforthefullrangeoffoodsactuallyusedtomeetnutrientneeds.Calculatingleast-costdietswithalowerdiversityoffoodsthanareactuallyavailableorincorrectcompositiondatawillresultinunrealisticcostsusinganinfeasiblecombinationoffoods.Unrealisticnutrientrequirements canalsoleadtounrealisticresults.

Outputs:CoNAshowstheminimumcostofachievingminimumnutrientadequacyforatargetpopulation(e.g.adultfemales,notpregnantorlactating),withnootherdietaryconstraints.Italsoshowswhichnutrientsarethemostconstraining,andwhichfoodscontributemosttomeetingeachnutrientrequirement.

CostofRecommendedDiet(CoRD)

Purpose:CoRD measurestheminimumcostofusinglocally-availablefoodstomeetdietaryrecommendations.Anysetofdietaryrecommendationscanbeused,providedtheyspecifyquantitativeservingrecommendations.Forpolicyrelevance,weoftenusefood-baseddietaryguidelines(suchasthosepictured,right).Thesespecifythequantityofeachfoodgroupneededforbothnutrientadequacyandpreventionofdiet-relatednon-communicablediseasewithinaculturallyacceptablediet.

Methods:CoRD iscalculatedbyselectingthelowest-costfoodswithineachgroup,insufficientquantitiestomeeteachrecommendation,usingdataon(1)thepriceofeachlocally-availablefood,(2)itsedibleportionandwatercontent,and(3)thetargetquantityneededtomeetrecommendations.

Outputs:CoRD measuresdietcostsforthesetofrecommendationsused.Nationalfood-baseddietaryguidelines(FBDG)areusuallyapplicabletothegeneralpopulation.WhereFBDGexistforspecificsub-populations(e.g.women,men,youngchildren),thesesub-populationguidelinescanbeappliedtotheanalysis.

ComparisontoothermetricsCoNA andCoRD aremarket-levelpriceindexesdesignedtomonitorthefoodenvironmentateachplaceandtime.Theybuildoneffortstoidentifythemostaffordablehealthydietfortargetpopulations,suchasOptifood (whichisusedtodeterminetheextenttowhichnutrientrequirementsforspecifictargetgroupscanbemetusinglocalfoodswithinexistingdietarypatterns)andtheCostoftheDiet(CotD)approachdevelopedbySavetheChildrenandusedintheWorldFoodProgramme’s FilltheNutrientGapanalysis(describedinfurtherdetailonthenextpage).CoNAandCoRD alsobuildonpreviousstudiesoffoodpricesthatfocusoncostpercalorieorforspecificfoodgroups,addingfactorsaffectingoveralldietcostssuchasnormativeguidelinesandmacronutrientdistributionranges.Allofthesecostmetricscanbecomparedtohouseholdincomeandexpendituredata,tocalculateaffordabilityasapercentageofaverageincomeortheproportionofhouseholdsthatcanaffordanutritiousdietineachtargetpopulation.

BeninFoodGuide

IndiaFoodGuide

KeyMetrics

Indicator PopulationDatarequiredandnutritionalstandardtobemet Resultsavailable Recommendeduses

CostofRecommendedDiet(CoRD)

(IANDA-CANDASAmetric)

Generalpopulation;atargetpopulationmaybespecifiediffood-baseddietaryguidelinesexistforthatpopulation

• Pricepergramofeachfood

• Dietaryrecommendations (e.g.nationalfood-baseddietaryguidelines)

• Quantityofeachfoodcategoryrecommended(e.g.400gramsoffruitsandvegetablesperday)

• Costperdayofmeetingdietaryrecommendations(suchasnationalfood-baseddietaryguidelines)

• Costperdayofeachfoodgroupintherecommendeddiet

• Costperservingofeachfoodgroupintherecommendeddiet

Monitoringthefoodenvironment ateachmarketplace,andregionallyandnationally

Usefultounderstandwhetherdietsthatfollowdietaryguidelinesareaffordabletomostpeople,andwhichfoodgroupsarethemostexpensive

Identifiesthelowest-costfoodsineachfood groupatanygiventimeandplace

CostofNutrientAdequacy(CoNA)

(IANDA-CANDASAmetric)

Anytargetpopulationofinterestforwhichnutrientrequirementsareavailable(e.g.adultwomen,pregnantwomen,youngchildren)

• Pricepergramofeachfood

• Nutrientcompositionofeachfood,intermsofenergy,protein,fat,ninevitaminsandsevenminerals(Fe,Zn,Ca,Mg,Cu,P,Se),andpotentiallyalsophytateasanantinutrient

• Nutrientrequirementsofthetargetpopulation,suchasestimatedaveragerequirements(EARs),upperlimits(ULs)andmacronutrientranges

• Costperdayofachievingnutrientadequacy

• Quantityandcostperdayofeachfoodandofeachnutrientinthelowest-costadequatediet

• Costperunitofeachlimitingnutrient,toshowthemostcostlynutrients

Monitoringthefoodenvironment ateachmarketplace,and regionally andnationally

Usefultounderstandwhetherdietsthatprovideadequatenutrientsareaffordabletomostpeople,andwhichnutrientsaremostexpensive.

Identifiesthelowest-costfoodstoprovidenutrientsatanygiventimeandplace

CostoftheDiet(CotD)andFilltheNutrientGap(FNG)

(SavetheChildrenandWFPmetric)

Acknowledgements:inputsonthissectionprovidedbySaskiadePee,Janosch Klemm,GiuliaBaldi,andAmyDeptford

Householdofacertaincomposition;oranytargetpopulationofinterestforwhichnutrientrequirementsareavailable(e.g.adultwomen,pregnantwomen,youngchildren)

• Pricepergramofeachfood

• Nutrientcompositionofeachfoodforenergy,protein,fat,ninevitaminsandfourminerals(Fe,Zn,Ca,Mg),usingembeddedfoodcompositiontable(withintheCotD software)orcustomdata

• EARsforenergy,percentageenergyfromfatandrecommendednutrientintakes(RNIs)

• Portionsizesforallfoodsfoundonthemarketusingembeddedportionsizedatabaseorcustomdata

• Optional:Typicalfoodhabitsofthehouseholdortargetindividuals

• Typical,average,or‘model’householdsizeandcompositionofthetargetarea

• Daily,monthlyand/orannualcostofachievingnutrientadequacy,alignedwithusualdietarypatterns,byseason(optional)forthemodelhouseholdandindividualswithinthehousehold

• Quantityandcostperday,week,oryearofeachfoodselectedbythemodel

• Theamountandpercentageofenergyandnutrientsprovidedbyeachedibleportionoffoodselectedbythemodel,summarizedbyday,weekoryear

• Thepercentageoftargetintakesmetforeachnutrientbyday,week,seasonoryear

• Costattributedtoeachfoodgroupperweek

Fill theNutrientGapisaprocessdesignedtoengagestakeholdersinasingleorperiodicassessmentofthecostofthediet,andrelevantpolicyoptions

Usefultomodelthelowestcostofmeetingnutrientneedswithinareasonablyrealisticdietarypattern,andthenshowwhatsuchadietwouldresembleforindividualsandthehousehold.

Usefultoidentifyimpactoffortificationorloweringcostoflocalnutritiousfoodsoncostofmeetingnutrientrequirements.

Asoftwarepackageisavailableforthemodeling,withembeddeddataonfoodcomposition,nutrientrequirements,andportionsizes.Trainingisrequiredtousethesoftware.

Summaryofmetricsofthecostofnutritiousdiets

SampleResults:CostofNutrientAdequacy(CoNA)

Seasonalvariationissignificantlygreaterfornutrients(redline)thanfordailyenergy(blueline)inTanzania

SeasonalrisesinthecostofnutrientadequacyaregreatestinthesouthernregionsinTanzania

ThisCoNA analysisusesfoodpricedataovertimeandacrossregionsinTanzaniatoshowthatthecostofnutrientadequacyismuchmorevariableacrossseasonsthanthecostofenergy(upperleft),andthatseasonalrisesinpricearegreatestinthesouth(upperright).Furtheranalysisrevealedthatthepricedifferenceismainlyduetoseasonalityinfruitsandvegetables.

OngoinganalysisinEthiopiashowsthatwhilewagesincreasedinEthiopiafrom2001-2016,thecostofnutrientadequacyremainedsignificantlyhigherthanthecostofcaloricadequacy.

Sources:• BaiYetal.(2019),andBachewe Fetal.(2019)• PresentedatIFPRI,PolicySeminaronMay292019.

Source:Baietal.2019

Source:Baietal.2019

Source:Bachewe etal.2019

CostofnutrientadequacyissignificantlyhigherthanthecostofcaloricadequacyinEthiopia,butbotharebecomingmoreaffordableaswagesrise

Trendsinthecostoftherecommenddietasapercentofwagesforruralunskilledlabor inIndia

ChangeinrecommendeddietaffordabilityacrossstatesinIndia,2001-2011

TheCoRD analysisinIndiausesnationalfood-baseddietaryguidelinesthatspecifyarangeofservingsforeachrecommendedfoodgroupseparatelyforwomenandmen,andactivitylevel.

TheseresultsshowthatinIndiafortheperiodcovered,recommendeddietsarehighlyunaffordable,andusinggender-specificrecommendations,costsarealargerfractionofunskilledwagesforwomenthanformen:70-80%ofwomen’swages,and50-60%ofmen’swages.

Thechangeovertimeincostofrecommendeddietsrelativetowageshasvariedbystate.Seasonalityinpricesishighestforfruitsandvegetables.

Source:Raghunathan K,HerforthA,&HeadeyD.2019.AffordabilityofnutritiousdietsinIndia.PresentedatIFPRI,PolicySeminaronMay292019.

SampleResults:CostofRecommendedDiet(CoRD)

IndiaFoodGuide

Since2016IANDA/CANDASAhasworkedwithGhanaianauthorities(GSS,MoFA)tohelpofficialsusethenewpriceindexeswithintheirroutinefoodpricemonitoring.

PolicyEngagement

2018:HeldameetingatANHAcademyWeek,whereGSSandMoFA statedintenttotracktheCostofRecommendedDietsandanutritiousfoodpriceindexasnationalstatistics.

2019:Tohelpintroducenewmetrics,aninformal“NutritiousFoodPricesAnalysisSupportGroup”willbehostedattheUniversityofGhana’sInstituteforStatistical,Social&EconomicResearch(ISSER),withthesupportofCANDASA.Thisistoallowgovernmentstatisticalofficerstomeetregularlywithlocaleconomistsandotherstakeholders,beforeandafterreleaseofnewdata,todiscussthe significanceandinterpretationofeachindicator.Meetingswillbeginmid-2019.

2016: IANDA held the first meeting with GhanaMinistry of Food and Agriculture (MoFA) and GhanaStatistical Service (GSS). We worked with thesenational agencies to understand the process of howfood price info is gathered, and reviewed the foodlists they use for food price monitoring. Together wedetermined that MoFA’s list could be updated toinclude more nutritious foods that are commonlyconsumed, such as nkontomire, a nutritious darkgreen leafy vegetable (pictured below).

2017: MoFA piloted the newexpanded food list and decided toupdate the food list used for foodprice monitoring nationwide. Weheld a workshop to discussinterest in monitoring the metricsas national statistics. An analysisby WFP showed that theexpanded food list gave morerealistic results in the CotD andFill the Nutrient Gap analysis.John Nortey from MoFA attendedthree global meetings (FAO andCFS) to present MoFA’s efforts atnutrition-sensitive metrics. JohnNortey (MoFA)presentedGhana’sleadershipinnutrition-sensitive

metricstotheWorldCommitteeonFoodSecurity(CFS)atFAOheadquarters(2017)

Photo:AHerforth,Ghana,2016