The Economics of Malnutrition

Hunger and undernourishment remain prominent issues worldwide. At the same time, obesity and nutrition related non-communicable diseases are soaring. In 2020, 1 in every 9 people globally are undernourished, over 2 billion people face micronutrient deficiencies and 1 in 3 people are found to be overweight or obese (Development Initiatives, 2020). These coinciding forms of malnutrition are highly alarming consequences of flawed food consumption patterns. Therefore, this dissertation will shed light on several patterns of malnutrition, how they are dispersed both across countries and within countries, and what influences them. First, Chapter 1 reviews evidence on the relationship between obesity, income and gender both within and across countries. We find that obesity rates change with income, but in a non-linear way. On average, obesity increases with income for poor countries, has no relationship with income for middle-income countries and decreases with income for rich countries. Within countries, obesity is concentrated among richer groups in low-income countries and evenly distributed in middle-income countries. In high-income countries, the poor are the most obese. The relationship differs for men and women, where women are more obese in low-income countries and much more obese in middle-income countries. The gender obesity gap disappears in high-income economies. The geographic concentration of obesity also changes with income growth: from urban areas in poor countries to rural areas in rich countries. Despite these patterns, total obesity rates continue to increase in all countries, and for the world as a whole. Second, urbanization is expected to have profound implications on health and nutrition. In sub-Saharan Africa, urbanization rates are booming at an annual average rate of 4%, compared to a world average of 2% (United Nations, 2019). Chapter 2 therefore assesses how child stunting, a widely used indicator of adverse nutritional status and health, evolves across different levels of urbanization in ten East African countries. This chapter uses nighttime light intensity as a continuous measure of urbanization to reveal large differences both between and within urban agglomerations. In all ten countries child stunting improves rapidly at low levels of urbanization. At the highest levels of urbanization two different trends can be discerned. For one group of countries the improvements level off, for the other group they deteriorate. The deterioration is especially notable for children from the two richest wealth quartiles. Investigating probable proximate causes of these patterns, we track how a number of determinants of child health vary with urbanization. Healthcare access and sanitation are found to improve with urbanization and so likely contribute to the initial improvements in child stunting. Child feeding practices, such as meal frequency, consumption of iron-rich foods and diet diversity, also improve initially but deteriorate at the highest levels of urbanization, possibly explaining why child health outcomes do not continue to improve or even worsen in the most economically active urban areas. Third, as child feeding practices are found to worsen with urbanization, Chapter 3 aims to disentangle dietary patterns between rural areas, secondary towns and highly urbanized areas in Tanzania. In order to do so, this chapter uses detailed information on exact food consumption during a two-week period. This allows the calculation of the macro- and micronutrient content of these diets with respect to the dietary reference intakes (DRIs). We find a significant difference in dietary composition between rural households, those living in secondary towns and those living in Dar es Salaam. Rural households mostly consume vegetables, cereals, roots and tubers, and fruit, but face under consumption issues and consequent nutrient deficiencies. Households living in secondary towns are more likely to fulfill the DRIs for all nutrients, whereas households in Dar es Salaam consume more fat, saturated fat and sugar, but less protein, fiber and key vitamins and minerals. The disparities in nutrient consumption between rural areas and secondary towns are partly explained by differences in wealth, educational levels, food prices and food accessibility. Other factors such as time constraints, supermarket availability and varying consumer preferences may influence the change in diets in Dar es Salaam. Fourth, food prices highly affect household consumption decisions in developing countries, especially as a large proportion of their income goes towards food (Hirvonen et al., 2020). Therefore, understanding food price evolutions and factors influencing these prices is important to inform appropriate food policies. Using price data from 116 markets in Ethiopia, Chapter 4 explains that real prices of all nutritionally-rich food groups increased significantly (between 23 and 74 percent) from 2005 to 2018. This contrasts with staple crops (grains, roots and tubers), whose price increased only slightly (6 percent), and with oils, fats and sugar, the prices of which decreased substantially (41 to 49 percent). Local price changes of nutritious foods are most highly influenced by prices in areas with a comparative advantage in the production of the product, demand factors in urban areas, and cross-country trade. In contrast, government subsidies and price controls have kept sugar and oil prices low. These findings warn against a degradation in dietary quality due to limited financial access to nutritious foods and the decreasing price of unhealthy foods. Fifth, this nutrition transition in developing countries from a diet rich in grains, root and tubers, and vegetables to one dominated by processed foods high in sugar and fat (Popkin, 2001), has increased interest in moving the measurement and analysis of nutritional choice beyond calories to a more complete understanding of macro- and micronutrient consumption (Finaret & Masters, 2019). To help move the literature on data collection forward, Chapter 5 uses six different survey modules to measure food consumption across Tanzania, three using diaries and three using recall methods. These modules were chosen to reflect the variety of modules currently in use in multi-purpose household surveys collecting food consumption expenditures at a national scale. Using the percentage consumed relative to the dietary reference intake of calories, protein, fats, sugars, fiber and 16 micronutrients, we find that the household diaries and 14-day recall systematically underestimate nutrient consumption compared to the benchmark personal diaries. The 7-day recall performs better, on average. We also calculate minimum cost diets and cost-of-basic needs food poverty lines in each region, the prevalence and depth of food poverty according to these lines, and the cost of targeted transfers designed to eliminate food poverty. The 7-day recall provides reasonable results whereas the 14-day recall grossly overestimates food poverty and therefore the hypothetical monetary transfer needed to alleviate this poverty.

Publication year:2020

Accessibility:Open