Marie Ruel IFPRI-FAO conference, "Accelerating the End of Hunger and Malnutrition" November 28–30, 2018 Bangkok, Thailand

1. Nutrition under
Rapid Urbanization
Plenary Session:
Nourishing Cities to Speed Progress
Marie Ruel, IFPRI
November 30, 2018
Bangkok, Thailand

2. Urbanization continues
to accelerate
Projected urban share
of global population
Urban
67%
20502014
Urban
54%
Growth of urban population
in major regions
2.8 Billion people
90% Asia & Africa

3. 2 BILLION
adults
are
overweight or obese
38 MILLION
children
are
overweight
2 BILLION
people
lack key micronutrients like
iron and vitamin A, Zinc
151 MILLION
children
are
stunted
51 MILLION
children
are
wasted
Sources: UNICEF/WHO/World Bank Group 2018
MALNUTRITION COMES IN MANY FORMS

4. Urban malnutrition
Urban dwellers suffer from all forms of malnutrition
0
5
10
15
20
25
30
35
40
Underweight Overweight
Rural Urban slum Urban non-slum
0
5
10
15
20
25
30
35
40
45
Urban Rural Urban Rural
1 2 3 4 5
Overweight
Nguyen et al. forthcoming Van Wesenbeeck et al. 2018
% %
Income Quintile
Underweight
West Africa (16 countries)India 2016
46%

5. Urban diets
The nutrition transition is
accelerating in cities
The “nutrition transition” is characterized by:
changes from traditional diets:
rich in coarse grains, staple cereals, and pulses to:
to more modern diets:
more diverse, including more animal sourced foods
(meat, dairy), oils, refined cereals, added sugars,
saturated fats, processed and ultra-processed foods
Photos: Michelle Holdsworth,
U. Sheffield; Ghana

6. Why are urban diets changing?
Supply and demand factors
❖ Globalization and trade liberalization have changed urban food
environments:
o Types & nature of foods available, prices, aggressive promotion & marketing of
select foods and beverages (oils, ultra-processed foods, sugar-sweetened
beverages)
o Purchasing options: fresh, frozen, packaged; fast food restaurants, supermarkets
❖ Changes in income, lifestyle, exposure to marketing affect food choices
o Employment, work away from home, women’s time, limited access to cooking
facilities – need for convenience; eating away from home; fast food, street foods
o Greater exposure to food marketing and advertising, changes in social norms,
desirability of modern foods and diets

7. Source: Barry Popkin, University of North Carolina at Chapel Hill; data from Euromonitor International Limited 2018
Ultra-processed foods
Trends in sales in select Asian countries (2005-2017)
0
5
10
15
20
25
30
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
China Malaysia Philippines Thailand India
Gramspercapitaperday
Sweet Biscuits, Snack Bars and Fruit Snacks
Salty Snacks
Confectionery
Cakes & pastries
Philippines
Thailand
India
China
Malaysia
Grams/capita/day

8. Source: Baker and Friel, 2014
Ultra-processed foods
Trends in sales in Asian countries, by level of GDP
0
50
100
150
200
250
300
Japan Singapore South Korea Taiwan
1999 2006 2012 2017
Indonesia Philippines India Vietnam Pakistan
1999 2006 2012 2017
Kg/capita/y
Higher-Income Lower-Middle-Income

9. Ultra-processed foods (UPF)
Diet and health risks
Sources: Cediel et al. 2017;
Steele et al. 2017; Monteiro et al. 2017
% Energy from protein (USA)
% Energy from added sugar (Chile)
Obesity (13 European countries)
% Energy intake from UPF
% Energy intake from UPF
% Household availability of UPF

10. Conclusions
❖ In urban areas, the most accessible, affordable, convenient diets are often
the most unhealthy
❖ Poor diets are associated with all forms of malnutrition
❖ Proposed accelerator: Redirect urban food environments towards
healthier diets and achieve Double Duty
o Make healthy foods/diets available, accessible, affordable, desirable
o Shift the demand towards healthier foods and diets through serious
investments in education, “aggressive promotion” and innovative and
behavior change communications approaches