The quantification of hidden costs in the 2023 edition of The State of Food and Agriculture for 154 countries amounted to 12.7 trillion dollars in 2020, of which more than 9 trillion (or 73 percent) were due to health-related costs. Because of the overwhelming share of health hidden costs associated with dietary patterns, the 2024 edition makes some refinements to their quantification. These refinements have led to the analysis expanding to 156 countries, up from 154, due to new data sources.c The new quantified hidden costs for these 156 countries amount to 11.6 trillion dollars globally, thereby confirming the previous edition’s conclusions that urgent and strategic action is needed to address them.
The new hidden cost estimates have changed what was considered to fall under unhealthy dietary patterns. The 2023 edition covered the quantified hidden costs associated with dietary patterns that lead to both obesity and non-communicable diseases. However, given concerns about the attribution of the hidden costs of high body mass index (BMI) to agrifood systems, as debated in the literature, the refinements drop BMI. The changes also break down the health hidden costs into dietary risk factors for NCDs from the Global Burden of Disease (GBD) study to highlight direct policy entry points.18 Box 4 provides an overview of the GBD data and Box 5 further details these refinements.
Box 4Global Burden of Disease data
Global Burden of Disease (GBD) data remain the most comprehensive and widely used global dataset on disease burdens in more than 200 countries. The standardized GBD estimates have been used by researchers, and national and international organizations to compare populations, track changes over time and monitor progress towards policy targets, including the Sustainable Development Goals.
To compile their estimates, GBD researchers contact numerous collaborators for pertinent data, such as official records and surveys. They prioritize those appearing in systematic reviews and meta-analyses to ensure their estimates are scientifically sound. There is then an extensive process of data cleaning and standardization. Subsequently, the researchers test a wide array of models for their predictive capabilities and select the combination that offers the highest predictive accuracy.20
Despite the careful treatment of data, GBD researchers acknowledge limitations to their estimates. In many cases, the primary data necessary for the estimate are lacking. In others, the data may be of low quality. In addition, some parameters of interest are still in the early stages of research, with various studies producing different estimates. Lastly, the mathematical models used to process and predict the data are subject to improvements in subsequent releases of the GBD dataset.
The continuous refinement of data and prediction methodologies has led to significant fluctuations in certain estimated relationships between diseases and their risk factors, sparking debate. Notably, estimates of deaths linked to unprocessed red meat consumption saw a 36-fold increase from 2017 to 2019. This surge was primarily due to the incorporation of additional causes of death related to red meat consumption. This dramatic change has drawn considerable criticism of the data sources used by the GBD.21, 22 Collaborators on the GBD report that the 2021 version of the GBD data – used herein – addresses these issues as much as possible.23
All things considered, the GBD data possess the scientific rigour necessary for the global analysis conducted in the 2023 and 2024 editions of The State of Food and Agriculture. Nonetheless, the subsequent estimates are, like all empirical results, subject to variability due to new evidence based on more and better primary data and methodologies, particularly in areas where research outcomes show greater heterogeneity.
Box 5Refining and breaking down global health hidden costs in order to identify levers
The health hidden costs for 154 countries quantified in The State of Food and Agriculture 2023 pertained to unhealthy dietary patterns contributing to obesity and non-communicable diseases (NCDs). Specifically, the analysis was based on data from the Global Burden of Disease (GBD) 2019 study and referred to 15 dietary risk factors leading to NCDs.24 It was assumed that 75 percent of the hidden costs due to high body mass index (BMI) could be attributed to agrifood systems. The analysis in this edition makes refinements to these estimates using data from the latest edition of the GBD study released in 2024, expanding the coverage to 156 countries, up from 154 in 2023.18
First, this edition of The State of Food and Agriculture removes the hidden costs of high BMI. This change is because the assumption regarding the attribution of BMI to agrifood systems is debated in the literature, as high BMI can be driven by other factors outside agrifood systems.17 The previous edition attempted to addressed this with a sensitivity analysis that varied the assumption from 50 to 100 percent to establish robustness. Second, this edition adds the dietary risks for NCDs associated with diets high in sugar-sweetened beverages in the refined global estimates, which were previously excluded to prevent double-counting with BMI. And third, health hidden costs are now broken down into dietary risk factors associated with NCDs from the GBD 2021 study. These refinements to the analysis are done with a heightened focus on direct policy entry points linked to dietary risk factors.
Globally, the hidden costs of diets low in whole grains account for 18 percent of all health hidden costs due to dietary risks associated with NCDs, followed by diets high in sodium and low in fruits (16 percent each). While diets high in processed and red meat receive a lot of attention in climate change discourse due to their significant impacts on the environment,13, 14 their share of hidden costs due to dietary risk factors associated with NCDs is far lower (8 and 7 percent, respectively) and comparable to the share of diets low in vegetables or diets low in nuts and seeds (see the figure). As the dietary risk factors account for the biggest share of the quantified health hidden costs of agrifood systems, potential policy levers to effectively address these hidden costs can only be identified through more granular context-specific assessments of risk factors, as in this report.
It is important to recognize that while these hidden costs help clarify some of the needed changes in dietary patterns, they only cover health hidden costs due to dietary risks related to NCDs. Unhealthy dietary patterns leading to other forms of malnutrition, which can be significant to varying degrees in different agrifood systems, are not included due to data limitations.
FIGURE Diets low in whole grains and fruits and high in sodium are the leading dietary risks contributing to global health hidden costs
SOURCES: Authors’ own elaboration based on Global Burden of Disease Collaborative Network. 2024. Global Burden of Disease Study 2021 (GBD 2021): Results. [Accessed on 7 June 2024. https://ghdx.healthdata.org/gbd-results; World Bank. 2021. World Development Indicators: GDP per person employed (2019). [Accessed on 29 January 2021]. https://data.worldbank.org/indicator/SL.GDP.PCAP.EM.KD. Licence: CC BY-4.0.
With these refinements, the global quantified health hidden costs pertaining to increased risk of NCDs amount to 8.1 trillion dollars. This is a decrease of around 13 percent, though these quantified health hidden costs still pertain to 70 percent of the global quantified hidden costs.d In addition, the patterns observed by country income group remain the same, with these costs highest in upper-middle- and high-income countries. By separating out the hidden costs of each diet-related risk factor for NCDs using the latest GBD data, this edition of the report provides more tangible policy levers for addressing them within a systems framework. Chapter 2 explores these results further through the lens of the agrifood systems typology.
