Global Panel Urbanization Policy Brief
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The brief looks at the challenge of providing healthy diets in urban environments, presenting eight policy recommendations which integrate actions from food, agriculture and nutrition into urban planning, education, health, sanitation, water and infrastructure development.
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Global Panel Urbanization Policy Brief
- 1. Urban diets and nutrition: Trends, challenges and opportunities for policy action
- 2. This policy brief Looks at the challenges of providing healthy diets in urban environments in LMICs. Highlights opportunities for governments and businesses to offer greater access to safe, affordable and nutritious foods.
- 5. Urban food systems are challenging because of: • The complexity of urban environments • The diversity of the population they serve
- 6. Higher consumption of: • Calories • Highly processed foods • Animal-sourced foods • Fruits and vegetables Greater access to a broader variety of fresh foods such as legumes, vegetables and fruits, as well as processed food with heath benefits. Characteristics of urban diets in LMICs
- 7. Increased household income gives access to a greater diversity of healthy foods, but also increase access to more ultra-processed foods. Urbanization and rising incomes do not automatically lead to better diets
- 8. Substantial dietary differences between high & low income groups. The urban poor frequently lack access to nutritious, safe and affordable foods. The urban poor
- 9. Urban malnutrition. A growing crisis • Undernutrition • Micronutrient deficiencies • Overweight, obesity & associated diet-related NCDs
- 10. City/Municipal government Should be the primary authority for assessing the dietary needs of their populations & for addressing food security & diet quality. Business sector Should view urban markets as an opportunity for higher profits, and a spur to industrial innovation. National government Should promote decentralisation, spread best practice to enhance diet quality, aligned with legislations and capacity building. Civil society organisations Should participate in cross-sector collaborations and act as challenge, holding all actors to account. Urban diets: priorities for intervention
- 11. 1. Rebalance their efforts in making high-quality diets a priority for both urban and rural populations. 2. At the local level, urban authorities to champion better diets and nutrition. 3. Capitalise on the opportunities for influence offered by urban food systems (product formulation, labelling, advertising and promotion). 4. Connect with wider areas of policy that affect urban food systems and nutrition (infrastructure, housing, transport and access to water and sanitation). The Global Panel recommends that policymakers:
- 12. 5. Address the needs of different urban population groups to achieve improved consumer access and dietary choice for all. 6. Change attitudes to the informal food sector, along with action to better address sanitary and health risks. 7. Give more attention to the specific challenges associated with rising rates of overweight and obesity. 8. Measure, analyse and disseminate efforts to tackle urban health and nutrition challenges. The Global Panel recommends that policymakers:
- 13. Twitter: Glo_PAN Download the brief: Glopan.org/urbanization
Editor's Notes
- Preamble remarks: I am delighted to be here on behalf of the Global Panel to highlight the challenge and opportunities of malnutrition in urban areas. The Panel, of which I am part, is a group of experts working with international, multi-sector stakeholders, to help governments in low and middle-income countries develop evidence-based policies that make high-quality diets safe, affordable and accessible.
- The Global Panel has produced peer-reviewed, evidence-based briefs providing an overview of the issues and suggestions for action across the food systems. Today I would like to concentrate on a last policy brief on urban diets, that we launched two weeks ago at the World Food Prize in Iowa.
- Recent decades have seen unprecedented population growth in urban areas. In 2014, just over half of the world’s population lived in towns and cities; this is expected to rise to two thirds by 2050. Nearly 90% of these additional 2.5 billion urban residents will be located in Africa and Asia.
- As shown in Fig. 1, urban population shares in Africa and Asia are currently lower than the global average of 54% (40% and 48% respectively in 2014) but those regions are urbanizing faster than others. These figures are projected to reach respectively 56% and 64% by 2050.
- Urban food systems are complex – able to pull food from the local farm sector as well as to tap supplies from around the world. So urban food environments encompass many different kinds of market outlets – from street food vendors to hypermarkets. And research shows that urban food environments are transforming at the rapid pace of demographic change. While urban and peri-urban agriculture are important sources of food in some towns and cities, most urban food systems are effectively driven by market factors. Urban food environments are also increasingly diverse – in terms of income, tastes, lifestyles, housing quality, access to water and sanitation services, the quality of jobs on offer, and the educational levels of individuals and families. In spite of this diversity and complexity, however, it is possible to make some broad generalizations about urban food systems, consumers’ interaction with these systems, the diets they consume, and the nutritional outcomes associated with these diets.
- In general, average urban incomes are higher than in rural areas and are increasing more rapidly with economic growth. The impact of these generally higher incomes lead to: GREATER CONSUMPTION OF CALORIES & HIGHLY PROCESSED FOODS: Studies in East and Southern Africa show that highly processed foods now account for more than one third of the purchased food market. This sharp rise mirrors income growth in both rural and urban areas. A recent study from six African countries shows that, as incomes rise, highly processed foods take an increasing share of the food basket value; this is true for rural as well as urban settings. In urban areas, in the highest income group, highly processed foods formed 65% of the value of the food basket compared to 35% for this group in rural areas. In general, high levels of processing add sugar, fat, and salt to the diet, adding calories with negative nutritional values that contribute to the rising trends of overweight and obesity in many urban areas However, it must be noted that not all food processing is nutritionally-suboptimal. Improved food safety, year-round availability, reduced waste and loss and the addition of needed nutrients through fortification are positive outcomes. URBAN CONSUMERS EAT MORE ANIMAL SOURCED FOODS: Urban inhabitants in LMICs consume more animal-sourced foods (fish, poultry, red and processed meat). In urban areas, there is a reduced reliance on starchy carbohydrates as dietary staples, a higher consumption of meat, but lower intake of dairy products. It is worth noting, though, that low-income urban consumers often continue to rely upon starchy staples as key elements of their diets. FRUIT AND VEG: Urban inhabitants in LMICs consume more fruits and vegetables. urban food environments are generally characterized by better availability of nutrient-rich but perishable fresh fruit and vegetables. Such foods tend to be more expensive than staples – so again their consumption reflects rising urban incomes – but another factor is the increasing availability of refrigeration and supermarkets, particularly in middle-income countries.
- So: Rising incomes can be a double edged-sword. As shown in the Foresight report, they give access to a greater diversity of healthy foods, but also increase access to more ultra-processed foods. As economies grow and urbanisation accelerates in LMICs, child stunting tends to decrease, but at a slower rate that the concurrent rise in adult overweight and obesity. Also, micronutrient deficiencies persist. Also, with rapidly expanding slums, a correlation between urban setting and better nutrition cannot be assumed.
- But poverty – evidenced by the growth of urban slums – also contributes to poor diets, poor nutrition and ill-health. The lack of income reduces the potential for poor populations to make healthy dietary choices. The lack of time as people work long hours in the informal sector to pursue income opportunities reduces the possibility of cooking healthy meals at home. And inadequate housing and kitchen facilities – including the lack of refrigeration – impose further constraints on poor urban households. Policymakers cannot avoid the diet and nutritional challenges faced by low-income urban residents. Worldwide, the number of urban dwellers living in informal settlements (slums) could be around one billion, with associated problems of access, poor water quality sanitation and pollution.
- So while urban residents have highly diverse purchasing and dietary patterns, the topline result of rising urban malnutrition is shared by all. Many urban environments are now experiencing a “triple burden” of malnutrition. Hunger (indicated by Stunting of children under five) and micronutrient deficiencies coexist with overweight, obesity, and the association diet-related non-communicable diseases. -- Further notes: UNDERNUTRITION: There has been significant progress in reducing global undernutrition in recent decades but the rate of decline remains slow. Although the global prevalence of stunted children has fallen from 39.6% in 1990 to 22.9% in 2016, 155 million children under five across the world continue to suffer from stunted growth. Globally, the proportion of stunted children living in cities has increased from 23% to 31%. This means that today, approximately one in three affected children is now in an urban environment. There is, however, substantial regional variation in how the number of undernourished urban children has changed over recent decades. For example, in sub-Saharan Africa, the region with the fastest-growing urban population, the number of undernourished children in cities more than doubled between 1985 and 2011. In contrast, the number of undernourished children in cities in East and Southeast Asia fell by more than 40% in the same period, despite the rising urban population. MICRONUTRIENT: There are currently no global estimates comparing deficiencies of minerals and vitamins for populations in urban and rural areas. This is due to the lack of disaggregated data. It’s important to acknowledge the triple burden of malnutrition in urban areas. Anemia in Mali: Weighted prevalence levels for all, mild, and moderate-to-severe anemia were 19.4, 12.0 and 7.4% in rural women. 23.4, 13.6 and 10.1% in urban women. Among women, the odds of anemia were higher among urban residents and those with higher socioeconomic status. (Source: Adamu AL. et al. 2017. Prevalence and risk factors for anemia severity and type in Malawian men and women: urban and rural differences. Population Health Metrics: Advancing innovation in health measurement 15:12 https://doi. org/10.1186/s12963-017-0128-2) OVERWEIGHT: In Africa, the number of overweight and obese children under five has nearly doubled since 1990 from 5.4 million to 10.3 million in 2014. In 2016, almost half of all overweight children under five lived in Asia and one quarter in Africa. In Chinese cities, the prevalence of obesity in urban areas is almost twice as high as rural areas.
- So what are the policy interventions the Global Panel recommends? There are three levels of interventions: research, governance and policy levels. If we want to focus on governance: