Chapter 4 Cost and Affordability of a Healthy Diet

Diet quality is an important predictor of nutritional status. Poor diet quality has been associated with different forms of malnutrition, such as undernutrition, micronutrient deficiencies and overweight and obesity. The Second International Conference on Nutrition in 20141 and the United Nations Decade of Action on Nutrition (2016–2025)2 have emphasized the need to ensure access to healthy diets to deliver on positive nutrition and health outcomes. Cost and affordability of a healthy diet indicators help to monitor people’s physical and economic access to a least-cost healthy diet using locally available foods to meet nutritional requirements set by food-based dietary guidelines.3 Any change in affordability over time can be the result of changes in either the cost of the diet or people’s income, or both. Rising food costs, if not matched by rising income, will lead to more people unable to afford a healthy diet. If food costs rise at the same time incomes fall, a compounding effect occurs that can result in even more people unable to afford healthy diets. It is therefore critical to monitor economic access to healthy diets to guide the governments and other stakeholders in promoting equity and livelihood opportunities to improve access to healthy diets as well as in putting social protection and safety nets in place to ensure that no one is left behind.4 1 FAO. ICN2 Second International Conference on Nutrition : better nutrition better lives. In: FAO. Rome, Italy, FAO. [Cited 12 September 2023]. https://www.fao.org/about/meetings/icn2/en/ 2 UN. 2023. United Nations Decade of Action on Nutrition 2016-2025. In: United Nations. New York, USA, UN. [Cited 12 September 2023]. https://www.un.org/nutrition/ 3 UN. 2023. United Nations Decade of Action on Nutrition 2016-2025. In: United Nations. New York, USA, UN. [Cited 12 September 2023]. https://www.un.org/nutrition/ 4 FAO, IFAD, UNICEF, WFP and WHO. 2022. The State of Food Security and Nutrition in the World 2022. Repurposing food and agricultural policies to make healthy diets more affordable. Rome, FAO. https://doi.org/10.4060/cc0639en

In 2021, worldwide, the average cost of a healthy diet increased by 4.3 percent compared to the previous year. The cost per person per day increased from 3.51 PPP dollars in 2020 to 3.66 PPP dollars in 2021. The cost grew higher in Asia and the Pacific (5.3 percent), moving from 3.94 PPP dollars in 2020 to 4.15 PPP dollars in 2021 (Figure 24 and Table 14). Between 2020 and 2021, the surge in food prices affected all subregions, especially Southern Asia, with a 6.9 percent increase in the cost of the diet, followed by Oceania (excluding Australia and New Zealand) (5.2 percent), South-eastern Asia (4.8 percent) and Eastern Asia (4.1 percent). Southern Asia is the only subregion where the cost has steadily risen since 2017 (Figure 25). In 2021, the lowest average cost was observed in Oceania (3.20 PPP dollars per person per day). Japan had the highest cost of a healthy diet (5.64 PPP dollars per person per day) followed by Bhutan (5.34 PPP dollars per person per day) (Table A1.14).

FIGURE 24.

Change in the cost of a healthy diet in Asia and the Pacific by subregion

Note: Please refer to Annex IV for the country coverage of this report. In particular, Central Asia and Western Asia are not included.
Source: Based on FAO. 2023. Cost and Affordability of a Healthy Diet (CoAHD). In: FAOSTAT. Rome. [Cited July 2023]. https://www.fao.org/faostat/en/#data/CAHD
Download: https://doi.org/10.4060/CC8228EN-fig24
TABLE 14.

Cost of a healthy diet

Cost (PPP dollars
per person per day)
Change (percent)
201720182019202020212017 to
2018
2018 to
2019
2019 to
2020
2020 to
2021
World3.303.363.433.513.661.82.32.34.3
Asia and the Pacific3.643.713.793.944.152.02.33.85.3
Eastern Asia4.174.344.454.674.874.22.45.14.1
Oceania2.852.852.963.043.200.13.82.85.2
South-eastern Asia3.683.783.863.994.192.72.13.64.8
Southern Asia3.493.573.663.824.082.22.74.26.9
Note: Please refer to Annex IV for the country coverage of this report. In particular, Central Asia and Western Asia are not included.
Source: Based on FAO. 2023. Cost and Affordability of a Healthy Diet (CoAHD). In: FAOSTAT. Rome. [Cited July 2023]. https://www.fao.org/faostat/en/#data/CAHD

When disaggregated by subregion, Southern Asia and Eastern Asia showed decreases in the number of people who could not afford the cost of a healthy diet, while South-eastern Asia showed increases in the number from 2020 to 2021. Oceania had a very slight increase in the number, from 0.7 million in 2020 to 0.8 million in 2021 (Figure 26).

Eastern Asia and Southern Asia showed improvement between 2020 and 2021, but unaffordability increased during the COVID-19 pandemic (2019–2020). The outbreak of COVID-19 and a lack of decent work opportunities in many parts of the region, alongside significant uncertainty of food systems and markets, led to a worsening of inequality, affecting poorer families disproportionately.5 While Eastern Asia in 2021 was able to recover (affordability in 2021 was lower than in 2019), this did not occur in Southern Asia (Figure 25 and Table 15). 5 FAO. 2021. COVID-19, skyrocketing food prices leave millions in Asia-Pacific hungry, malnourished, UN agencies report. In: FAO. Manila, Philippines, FAO. [Cited 12 September 2023]. https://www.fao.org/philippines/news/detail/en/c/1370160/

FIGURE 25.

Change in the number of people unable to afford a healthy diet in Asia and the Pacific by subregion

Note: Please refer to Annex IV for the country coverage of this report. In particular, Central Asia and Western Asia are not included.
Source: Based on FAO. 2023. Cost and Affordability of a Healthy Diet (CoAHD). In: FAOSTAT. Rome. [Cited July 2023]. https://www.fao.org/faostat/en/#data/CAHD
Download: https://doi.org/10.4060/CC8228EN-fig25
TABLE 15.

Number of people unable to afford a healthy diet (millions)

NumberChange
201720182019202020212017 to
2018
2018 to
2019
2019 to
2020
2020 to
2021
World3 124.93 019.13 005.53 191.93 139.5-105.8-13.6186.4-52.4
Asia and the Pacific1 999.11 884.51 854.12 006.51 926.1-114.6-30.4152.4-80.4
Eastern Asia238.7197177.8230.9159.4-41.7-19.253.1-71.5
Oceania0.60.60.70.70.80.00.10.00.1
South-eastern Asia348.6343335.1349357.4-5.6-7.913.98.4
Southern Asia1 411.31 343.91 340.61 425.91 408.5-67.4-3.385.3-17.4
Note: Please refer to Annex IV for the country coverage of this report. In particular, Central Asia and Western Asia are not included.
Source: Based on FAO. 2023. Cost and Affordability of a Healthy Diet (CoAHD). In: FAOSTAT. Rome. [Cited July 2023]. https://www.fao.org/faostat/en/#data/CAHD

More than 50 percent of the population were unable to afford a healthy diet in 2021 in Mongolia (Eastern Asia), Fiji (Oceania), Indonesia, the Lao People’s Democratic Republic, Myanmar, and Philippines (South-eastern Asia) and Bangladesh, India, Nepal, Pakistan and Sri Lanka (Southern Asia). For Southern Asia, there was some improvement in affordability in 2020 compared to 2021 in Bangladesh, India and Maldives, no change in Bhutan, Nepal and Pakistan, and deterioration in the Islamic Republic of Iran and Sri Lanka. Overall, Pakistan has the highest percent of its population (over 80 percent) who were unable to afford a healthy diet in 2021.

FIGURE 26.

Percentage of people unable to afford a healthy diet in Asia and the Pacific by country and subregion

Note: Please refer to Annex IV for the country coverage of this report. In particular, Central Asia and Western Asia are not included.
Source: Based on FAO. 2023. Cost and Affordability of a Healthy Diet (CoAHD). In: FAOSTAT. Rome. [Cited July 2023]. https://www.fao.org/faostat/en/#data/CAHD
Download: https://doi.org/10.4060/CC8228EN-fig26