- ➔ New food price data and methodological improvements have resulted in updated estimates of the cost and more accurate estimates of the affordability of a healthy diet, leading to a revision of the entire series of both sets of indicators.
- ➔ Food prices rose throughout 2022, pushing up the average cost of a healthy diet globally to 3.96 purchasing power parity (PPP) dollars per person per day, up from 3.56 PPP dollars in 2021. Disruptions from the COVID-19 pandemic and the war in Ukraine contributed to significant increases in international food and energy prices, exacerbating inflationary pressures.
- ➔ Despite the increase in food prices over 2022, the number of people unable to afford a healthy diet in the world fell back to pre-pandemic levels in the same year (2.83 billion people), fuelled by an economic recovery from the pandemic that has, nevertheless, been uneven across regions and country income groups.
- ➔ The number of people unable to afford a healthy diet dropped below pre-pandemic levels in Asia and in Northern America and Europe, while increasing substantially in Africa, where the number rose to 924.8 million in 2022, up by 24.6 million from 2021, and by 73.4 million from 2019.
- ➔ The unequal recovery is even more evident across country income groups. In 2022, the number of people unable to afford a healthy diet dropped below pre-pandemic levels in the group of upper-middle- and high-income countries as a whole, while the group of low-income countries had the highest levels since 2017, the first year for which FAO published estimates. This suggests that limited fiscal capacity in low-income countries provided only partial protection from the negative impacts of these crises.
- ➔ Of the people in the world who were unable to afford a healthy diet in 2022, 1.68 billion, or 59 percent, lived in lower-middle-income countries. However, low-income countries had the largest percentage of the population that could not afford a healthy diet (71.5 percent) compared with lower-middle-income countries (52.6 percent), upper-middle-income countries (21.5 percent) and high-income countries (6.3 percent).
Monitoring economic access to a healthy diet is essential for informing policies aimed at improving food security and nutritional outcomes, thereby contributing to the achievement of SDG Targets 2.1 and 2.2. A healthy diet comprises four key aspects: diversity (within and across food groups), adequacy (sufficiency of all essential nutrients compared to requirements), moderation (foods and nutrients that are related to poor health outcomes) and balance (energy and macronutrient intake).
The cost of a healthy diet (CoHD) indicator provides national level estimates of the cost of acquiring the cheapest possible healthy diet in a country, defined as a diet comprising a variety of locally available foods that meet energy and nutritional requirements.25
The CoHD is then compared with national income distributions, after careful consideration of the portion of income required for essential non-food goods and services, to estimate the prevalence of unaffordability (PUA) and the number of people unable to afford a healthy diet (NUA) indicators. These are measures of the proportion of the population and of the number of people in each country who are unable to afford even the least-cost option of a healthy diet. Together, the PUA and NUA serve as critical indicators for monitoring the inability of agrifood systems to deliver a least-cost healthy diet that is accessible for all, given existing levels of income inequality within countries.
In this year’s edition of the report, the indicators of the cost and of the affordability of a healthy diet are updated to 2022.f FAO, in collaboration with the World Bank, systematically monitors these indicators and disseminates the series in the FAOSTAT database and in the World Bank Databank. The entire series for both indicators have been revised as a result of the introduction of three significant updates in the calculation of the indicators (see Supplementary material to Chapter 2).
First, the CoHD estimates for 2017 to 2022 were calculated using updated retail food prices for the year 2021 from a new round of the International Comparison Program26 released by the World Bank, replacing the 2017 ICP round adopted in previous editions of this report.27
Second, in this year’s edition, the prevalence and number of people unable to afford a healthy diet at global, regional and country income group levels have been imputed for the first time for countries with missing information (see Annex 1B).g
Third, we are introducing an important revision in the methods used to compute the PUA and NUA indicators. Specifically, in establishing an appropriate cost threshold to compare with country-specific income distributions, it is essential to identify the cost of basic non-food needs as well as the cost of a healthy diet. A new method to determine the cost of basic non-food goods and services is introduced, which allows for a more accurate reflection of how this cost varies for countries that belong to different income groups (see Box 4 and Annex 1B).
BOX 4ONGOING IMPROVEMENTS IN THE METHOD TO ASSESS THE AFFORDABILITY OF A HEALTHY DIET
Establishing new indicators for global assessments like those presented in this section is always a daunting task. Since they were first introduced in the 2020 edition of this report, the indicators of the unaffordability of a healthy diet (prevalence and number) at the global, regional and country levels have been continuously refined to reflect both newly available information and a more thorough understanding of some of the subtlety involved in the underlying statistical inferential process.
In addition to the normal practice of updating them based on more recent data, the series presented in this edition of the report reflects a more substantial revision of the method, replacing the one used in the past.
As far as data are concerned, the main aspect to note this year is that all estimates of the cost of a healthy diet (CoHD) at country level have been revised to reflect the 2021 food price recently released in the 2024 edition of the International Comparison Program.26 As prices have been added for new food items that were not included in previous releases, this entailed reviewing, as necessary, the composition of the reference Healthy Diet Basket.28
In terms of methods, while the general principle on which the indicators are based remains unchanged, the way in which it has been operationalized to compute the estimates has been revised. Affordability means that people can devote enough money to food to purchase locally all the least expensive food items needed to consume a healthy diet. This excludes the possibility of consuming expensive food items if a nutritionally equivalent, lower-cost option is available.
When determining how much of a household’s total disposable income can be reasonably devoted to food, it is important to consider the minimum amount that people must reserve to purchase the non-food basic goods and services needed to conduct a dignified life. In past editions of this report, this amount was roughly approximated by a fixed proportion (48 percent) of the household’s total disposable income.29 The same percentage was applied to all countries, justified by the observation that, on average, people in low-income countries spend 52 percent of their income on food. Furthermore, it was assumed that using this average proportion would not introduce a systematic bias, despite the expectation that poor people must devote relatively more of their income, and wealthier people relatively less, to basic food needs. In hindsight, the assumption that the implicit misclassification errors would cancel out, in the aggregate, was incorrect.
This year FAO, in collaboration with the World Bank, began implementing a change to the methodology to reflect the fact that the amount needed to purchase non-food basic goods and services varies across households in ways that are not simply proportional to their income.
The ideal approach would entail determining, for each country separately, the cost of a normatively defined bundle of such goods and services, based on market prices (similarly to what we do to price the cost of a healthy diet). Unfortunately, such an approach is not feasible as it would require deciding what is to be included in the bundle of essential goods and services and having access to detailed prices on those goods and services.
Due to the lack of country-specific information needed to determine the cost of basic non-food goods and services, this edition employs a feasible approach based on the World Bank’s country classifications by income. The approach defines non-food spending as the daily cost evaluated at the country income group’s international poverty line and assigns non-food spending shares related to each group.* The new method involves multiplying country income group-specific international poverty lines by the non-food expenditure shares for each country income group to calculate the daily cost of basic non-foods in a country, as illustrated in Table A.
For each country a threshold is computed that combines the least-cost healthy diet of the country (i) and the income group-specific cost of non-food basic needs (j):
Cost Thresholdi = CoHDi + (IntlPovLinej × NonfoodExpShare Incomej)
TABLE A CALCULATION OF THE COST OF NON-FOOD BASIC GOODS AND SERVICES
Finally, this threshold is compared with the country-specific income distribution sourced by the World Bank Poverty and Inequality Platform to estimate the percentage of the population whose income is below that threshold. In this way, it is recognized that the cost to achieve a minimally adequate standard of living differs depending on the level of economic development of the country, which is very much in line with the concept behind the higher poverty lines used by the World Bank to monitor poverty in countries with a low incidence of extreme poverty.30 This revision corrects for the overestimation of unaffordability in low- and lower-middle-income countries and the underestimation in upper-middle- and high-income countries, both derived from using a fixed share of income to cover for non-food basic needs. Figure A shows the extent of the corrections made in the series of unaffordability in each country income group.
FIGURE A Adjustment in the series of unaffordability by country income group, 2017–2022
As mentioned, this is the first step towards a more thorough revision of the methods used to assess the prevalence of unaffordability of a healthy diet. However, it is also important to address the fact that the cost to achieve a minimally dignified standard of living also varies within each country. Especially for large and diverse countries, the failure to account for such differences, and the use of a threshold set at the national average for the cost of basic non-food needs and healthy diets, may result in biased estimates of unaffordability. The direction and extent of the bias will depend on the direction and the magnitude of the possible correlation that exists between income levels and the correct, location-specific threshold.
Research is ongoing, based on analysis of data from a large number of Household Consumption and Expenditure Surveys, to establish the proper correction factor to apply to the country-specific thresholds to correct the bias, and the results will be presented in the next edition of this report. See Annex 1B and Supplementary material to Chapter 2 for further details on the methodology.
All of this has resulted in a recalibration of the whole series of PUA and NUA estimates to levels that are significantly lower than those published in previous editions of this report.
The cost of a healthy diet in 2022
Food prices continued to rise in 2022 compared to the period from 2017 to 2021, pushing up the average cost of a healthy diet (CoHD) globally and in all regions of the world. The FAO Food Price Index climbed by 52 percent between 2019 and 2022, with prices for cereals increasing by 60 percent, dairy products by 45 percent, meat by 19 percent, and oils by a remarkable 125 percent compared to pre-COVID-19 pandemic levels.33
This inflationary pressure is reflected in the trend of the CoHD indicator, which has risen worldwide since 2017 (the first year for which FAO disseminates estimates), peaking at an average of 3.96 PPP dollars per person per day in 2022 (Table 5). Between 2020 and 2021, the CoHD rose 6 percent, from 3.35 to 3.56 PPP dollars, while the following year, it increased by 11 percent, from 3.56 PPP dollars in 2021 to 3.96 PPP dollars in 2022.
TABLE 5The average cost of a healthy diet, 2017–2022
SOURCE: FAO. 2024. FAOSTAT: Cost and Affordability of a Healthy Diet (CoAHD). [Accessed on 24 July 2024]. www.fao.org/faostat/en/#data/CAHD. Licence: CC-BY-4.0.
The cost of a healthy diet across regions in 2022, is found to be highest in Latin America and the Caribbean (an average of 4.56 PPP dollars), with an increase of nearly 12 percent in only one year. In Asia, the average CoHD rose from 3.84 PPP dollars in 2021 to 4.20 PPP dollars, with Eastern Asia and Southern Asia recording the highest average CoHD at 5.34 PPP dollars and 4.28 PPP dollars, respectively, in the region. Africa saw a 10 percent increase in CoHD from 3.41 PPP dollars in 2021 to 3.74 PPP dollars in 2022, with Western Africa experiencing the largest surge, 11 percent between 2021 and 2022, followed by Eastern Africa (8.6 percent). Northern Africa was the only subregion where the average CoHD decreased between 2019 and 2020; it rose by 10 percent from 2021 to 2022. Compared to the other regions, Northern America and Europe showed a moderate increase in the average cost of a healthy diet during the COVID-19 pandemic (from 2.95 PPP dollars in 2019 to 3.12 PPP dollars in 2021), but experienced a substantial increase of 14 percent from 2021 to 2022, reaching 3.57 PPP dollars. In Oceania, the CoHD averaged 3.46 PPP dollars in 2022. Broken down by income group, lower- and upper-middle-income countries recorded the highest average cost of a healthy diet in 2022 at 4.20 PPP dollars per day. This was followed by high-income countries at 3.78 PPP dollars, and low-income countries at 3.48 PPP dollars. In low-income countries, the average cost of a healthy diet increased by nearly 5 percent between 2021 and 2022, following a 10 percent surge in the cost from 2020 and 2021.
The prevalence and number of people unable to afford a healthy diet in 2022
The 2023 edition of this report pointed to a slight turnaround in the number of people unable to afford a healthy diet in 2021, when it declined compared to 2020, although it was still higher than it was at pre-pandemic levels in 2019. Despite the increase in food prices over 2022, this year’s edition confirms the continuation of a declining trend in the number of people unable to afford a healthy diet in 2022, largely due to the path of economic growth since the pandemic. Worldwide, an estimated 35.4 percent of people (2.83 billion) were unable to afford a healthy diet in 2022, compared with 36.4 percent (2.88 billion) in 2021, equivalent to a decrease of 50.1 million people in one year (Figure 8 and Table 6). After declining by 238 million people, from 3.06 billion in 2017 to 2.82 billion in 2019, the number of people unable to afford a healthy diet rose to 2.97 billion people in 2020, coinciding with the COVID-19 pandemic period. This was followed by a two-year declining trend in the prevalence and the number of people unable to afford a healthy diet.
FIGURE 8 The proportion of the population and number of people unable to afford a healthy diet in the world decreased from 2020 to 2022
TABLE 6Proportion of the population and number of people unable to afford a healthy diet, 2017–2022
SOURCE: FAO. 2024. FAOSTAT: Cost and Affordability of a Healthy Diet (CoAHD). [Accessed on 24 July 2024]. www.fao.org/faostat/en/#data/CAHD. Licence: CC-BY-4.0.
However, the recovery has been uneven across regions. The unaffordability of a healthy diet dropped below pre-pandemic levels in Asia and in Northern America and Europe, while increasing substantially in Africa, where the NUA rose to 924.8 million in 2022, up by 24.6 million from 2021, and by 73.4 million from 2019 (Table 6). In Asia, a healthy diet was out of reach for 1.66 billion people in 2022, showing two consecutive years of improvement; 163 million fewer people were unable to afford a healthy diet in 2022 than in 2020. In Latin America and the Caribbean, while the number of people unable to afford a healthy diet increased by 9.2 million from 2020 to 2021, this was more than offset by an improvement of 14.3 million in 2022, bringing the total number down to 182.9 million in 2022. In Northern America and Europe, the burden of unaffordability was also alleviated, decreasing from 57.1 million in 2021 to 53.6 million in 2022. Oceania also saw a reduction, from 10 million in 2021 to 9.1 million in 2022.
Sub-Saharan Africa experienced a significant deterioration in 2022, when the number of people unable to afford a healthy diet rose by 23.9 million to 842.9 million. The majority of people who lacked economic access to a healthy diet in 2022 lived in Eastern Africa (348.6 million) and Western Africa (297.5 million). These two regions combined saw an increase of 18.9 million in the number of people unable to afford a healthy diet from 2021 to 2022. Northern Africa showed a decline in the number from 2020 to 2021 (from 89.9 million to 81.2 million), followed by a slight uptick in 2022. Nevertheless, Northern Africa had the lowest prevalence in the region at 31.5 percent. Southern Asia recorded a decline in the number for the second consecutive year, with 44.2 million fewer people unable to afford a healthy diet, fully offsetting the increase in the wake of the COVID-19 pandemic in 2020. Western Asia also saw a recovery, with 2.7 million fewer people unable to afford a healthy diet. Following a significant improvement in 2021 (78 million fewer people), Eastern Asia’s recovery continued in 2022, with 3.9 million fewer people unable to afford a healthy diet. In Central Asia, the number of people unable to afford a healthy diet slightly decreased to below pre-pandemic levels (12.6 million). In South America, the number of people unable to afford a healthy diet decreased notably from 126 million to 113.6 million, driving the regional decline. While no change was noted in Northern America, Europe experienced a significant decrease in the prevalence of unaffordability, from 6.4 percent in 2021 to 5.9 percent in 2022, with 3.4 million fewer people unable to afford a healthy diet. This change was mainly driven by improvements in Eastern Europe and Southern Europe.
The unequal recovery is even more evident across country income groups. Low-income countries had negative growth in GDP per capita in 2020 and 2021 followed by a slight recovery in 2022.34 The halt in economic growth, coupled with the sharp rise in food prices, has significantly reduced disposable incomes, given that food makes up a larger share of household expenditures in low-income economies.35 This has made the recovery path slower for low-income countries, which have the highest number of people unable to afford a healthy diet since 2017; a healthy diet was out of reach for 503.2 million people in low-income countries in 2022.
Lower-middle-income countries showed a declining number of people unable to afford a healthy diet from 2020 to 2022, albeit still above pre-pandemic levels of 2019. This improvement was favoured by sustained per capita gross domestic product (GDP) growth in 2021 and 2022, surpassing the levels seen in 2019.34 In the groups of upper-middle- and high-income countries, on the other hand, the number fell well below pre-pandemic levels in 2022 (Table 6). A rebound in GDP growth, along with the ability to deploy fiscal policies that cushion the adverse economic impacts during times of crisis, played an important role in these countries.35 While targeted fiscal policies fully counteracted the impact of the COVID-19 pandemic and other multiple shocks on the affordability of healthy diets in richer economies, they mitigated only a part of the impact in low-income countries.
Of the people in the world who were unable to afford a healthy diet in 2022, 1.68 billion, or 59 percent, lived in lower-middle-income countries (Figure 9). In terms of proportion, however, low-income countries showed the largest share of the population that could not afford a healthy diet (71.5 percent) compared with lower-middle-income (52.6 percent), upper-middle-income (21.5 percent) and high-income countries (6.3 percent) (Table 6).
FIGURE 9 Three-quarters of the people who are unable to afford a healthy diet live in low- and lower-middle-income countries
SOURCE: FAO. 2024. FAOSTAT: Cost and Affordability of a Healthy Diet (CoAHD). [Accessed on 24 July 2024]. www.fao.org/faostat/en/#data/CAHD. Licence: CC-BY-4.0.
Economic access to food is one component of food security. People who cannot afford the least-cost healthy diet are likely facing at least some degree of food insecurity, with negative consequences for the quality of their diet. Poor diets, in turn, are an important determinant of nutritional outcomes, which are the focus of the next section.
