A laborer prepares fruit plates on his pushcart before breaking fast during the fasting month of Ramadan along a road in Karachi, Pakistan. Photo by: REUTERS / Akhtar Soomro

BERLIN — When new research came out in November showing that the EAT-Lancet reference diet was too costly for nearly 1.6 billion people in the world, headlines zeroed in on the diet's unaffordability as the latest evidence of its impracticality.

The EAT-Lancet guidelines, which were unveiled earlier this year, were meant to advance toward a food system that nutritiously feeds all of the world's estimated population of 10 billion people in 2050, while also accounting for environmental sustainability.

It drew quick criticism from richer countries and from industry, particularly for slashing the average meat intake in those places. And low-income communities faulted the commission that drew up the guidelines for presenting an idealized diet that failed to account for what they can actually access. Now the new research indicates it also exceeds what many people — particularly in Africa and South Asia — can afford.

"The EAT-Lancet diet gets some criticism, but any recommended diet would be expensive for poor people. It's not something that's just specific to the EAT-Lancet diet."

— Derek Headey, co-author of the “Affordability of the EAT-Lancet reference diet” report

But this latest criticism misses the fact that most reference diets and guidelines are priced above the poverty line, the authors of the new study told Devex. While they might have some specific critiques of the EAT-Lancet diet, including its lack of focus on the nutritional needs of young children, the broader fault lies in systemic issues, such as the way food systems operate and how much people are paid for their work. The research also underscores the reality that achieving a nutritious, environmentally sustainable diet will require a lot more than focusing on just what people eat.

"If the dietary targets would be helpful for health and planet and if some of these foods are expensive or the diet is unaffordable, then it indicates there is something wrong in the food system or the economic system and we ought to fix it," said Kalle Hirvonen, a senior research fellow at the International Food Policy Research Institute, and the lead author of the study. "This is a very useful alert to focus on these issues and work harder,” Hirvonen said.

Extension of the EAT-Lancet diet

The EAT-Lancet Commission, which drew together 37 scientists from 16 countries, was not tasked with considering affordability. Their job was to create a reference diet that would address the twin issues of malnutrition and the food system's contribution to planetary degradation by crafting a diet that, if globally adopted, would solve both.

Hirvonen sees the new findings on affordability, from a team of researchers at IFPRI and the Friedman School of Nutrition Science and Policy at Tufts University, as supplementing that original effort. "Our work was not meant to be a criticism of their work," he said. "It was an economic extension of their work."

His team used the International Comparison Program, led by the World Bank, to compare prices for 744 foods across 159 countries. What they found is that, at its most affordable, the median cost of adhering to the EAT-Lancet diet was $2.84 per day — well above the global poverty line of $1.90 per day set by the World Bank, and immediately out of the range of 1.58 billion people, who make up the world’s lowest earners.

Derek Headey, a co-author of the research and a senior research fellow in IFPRI's poverty, health, and nutrition division, said the number who would not be able to afford it was likely more, once you consider that they must also pay for other necessities, including rent and transportation, out of their income.

The researchers also determined that the diet was 64% more expensive than the combination of foods that would provide a mix of 20 essential nutrients at the lowest cost. But even that diet might not be affordable for or available to everyone.

"The EAT-Lancet diet gets some criticism, but any recommended diet would be expensive for poor people," Headey told Devex. "It's not something that's just specific to the EAT-Lancet diet."

The World Bank calculated that the cost of eating an ideal diet based on national guidelines in several Southeast Asian countries ranged from $1.20-$2 per day, with fluctuations depending on the season and the location. And that work didn't even attempt to take on the EAT-Lancet Commission's additional task of adjusting for environmental sustainability.

Local context

EAT-Lancet was never going to find a one-size-fits-all solution. And while the commission attempted to demonstrate the diet's flexibility by actually presenting a variety of different meals, the reality is it was never going to be adopted wholesale into a local context.

"EAT-Lancet doesn't change a basic fact that a nutritious diet for billions of people is unaffordable, however it is composed," Steve Godfrey, director of policy and external relations at the Global Alliance for Improved Nutrition, explained in an email. "The differential impact on prices, affordability, accessibility of the reference diet is highly context-specific."

It can help, though, in informing national recommendations, particularly in countries that do not have their own dietary guidelines. Hirvonen pointed out that at the moment only seven African countries have created food-based dietary guidelines.

The EAT-Lancet reference diet can then serve as a starting point for building guidelines that reflect local realities — both in terms of affordability and availability — and that take into account seasonal variations. And it can jumpstart conversations about the kinds of interventions and investments that are needed to bring any national guidelines closer to the universal standard.

That includes grappling with the problem that people's incomes simply do not allow them to afford a healthy diet and that food value chains may not be weighted in a way to prioritize the production or distribution of nutrient-dense foods.

"We need a much larger safety net and much larger transfers to get poor people into the realm of affording a healthy diet," Headey said. And that is before strategists get to the huge issue of preference. Even in countries where people can afford to adhere to healthier, more sustainable diets, they choose not to. There is a pressing need to figure out how to change their behaviors and to instill more nutritious, sustainable preferences in new generations.

These problems require more attention — and collaboration — among a range of people involved in policy, production, and distribution, but they also require time and population growth. As more people are concentrated in urban centers in some global south countries, for instance, it may create a demand for nutritious foods that are currently not financially sustainable to produce and distribute, Headey said.

What the EAT-Lancet diet has done is to help train attention on just how interrelated all of these issues — food systems, income, nutrition, and planetary health — are.

"We're working hard as a development community to alleviate poverty," Hirvonen said. "But even if you reach the poverty line, that might not be enough to follow a healthy or sustainable diet. It's depressing in that sense that there's so much work we need to do."

This focus area, powered by DSM, is exploring innovative solutions to improve nutrition, tackle malnutrition, and influence policies and funding. Visit the Focus on: Improving Nutrition page for more.

About the author

  • Andrew Green

    Andrew Green is a Devex Contributing Reporter based in Berlin. His coverage focuses primarily on health and human rights and he has previously worked as Voice of America's South Sudan bureau chief and the Center for Public Integrity's web editor.