Affordability of the EAT-Lancet reference diet: a global analysis

Abstract

Background: The EAT-Lancet Commission drew on all available nutritional and environmental evidence to construct the first global benchmark diet capable of sustaining health and protecting the planet, but it did not assess dietary affordability. We used food price and household income data to estimate affordability of EAT-Lancet benchmark diets, as a first step to guiding interventions to improve diets around the world.

Methods: We obtained retail prices from 2011 for 744 foods in 159 countries, collected under the International Comparison Program. We used these data to identify the most affordable foods to meet EAT-Lancet targets. We compared total diet cost per day to each country's mean per capita household income, calculated the proportion of people for whom the most affordable EAT-Lancet diet exceeds total income, and also measured affordability relative to a least-cost diet that meets essential nutrient requirements.

Findings: The most affordable EAT-Lancet diets cost a global median of US$2·84 per day (IQR 2·41-3·16) in 2011, of which the largest share was the cost of fruits and vegetables (31·2%), followed by legumes and nuts (18·7%), meat, eggs, and fish (15·2%), and dairy (13·2%). This diet costs a small fraction of average incomes in high-income countries but is not affordable for the world's poor. We estimated that the cost of an EAT-Lancet diet exceeded household per capita income for at least 1·58 billion people. The EAT-Lancet diet is also more expensive than the minimum cost of nutrient adequacy, on average, by a mean factor of 1·60 (IQR 1·41-1·78).

Interpretation: Current diets differ greatly from EAT-Lancet targets. Improving diets is affordable in many countries but for many people would require some combination of higher income, nutritional assistance, and lower prices. Data and analysis for the cost of healthier foods are needed to inform both local interventions and systemic changes.

Funding: Bill & Melinda Gates Foundation.

Figure 1

Cost of the EAT–Lancet reference diet in 2011 international dollars, by country income levels and major regions We used price data from the International Comparison Program to estimate the cost of the EAT–Lancet reference diet in 159 countries. Cost estimates are reported in 2011 international dollars, adjusting for inflation using purchasing power parity price levels for household consumption. The size of the box indicates the IQR. The bottom and top rule marks the bottom 5th and top 5th percentiles, respectively. The vertical bar rule inside the box shows the median value for the income group or geographical region.

Figure 2

Cost of the EAT–Lancet reference diet relative to mean daily per capita household income by country income levels and major regions We used price data from the International Comparison Program to estimate the cost of the EAT–Lancet diet and compared these estimates to mean daily per capita household income. The size of the box indicates the IQR. The bottom and top rule marks the bottom fifth and top fifth percentiles, respectively. The vertical bar rule inside the box shows the median value for the income group or geographical region. N=141 countries.

Figure 3

Comparing the cost of EAT–Lancet reference diets to the minimum cost of nutrient adequacy, by level of national income or geographical region We used price data from the International Comparison Program to estimate the cost of the EAT–Lancet diet in 159 countries, and computed the cost of meeting only estimated average requirements, upper limits and average macronutrient distribution ranges for essential nutrients. At the dashed vertical line, the two diets would have identical cost. Data shown are the cost of an EAT–Lancet diet as a multiple of the nutrients-only diet—for example, a value of 1·5 represents a 50% higher cost. The size of the box indicates the IQR. The bottom and top rule marks the bottom fifth and top fifth percentiles, respectively. The vertical bar rule inside the box shows the median value for the income group or geographical region. N=159 countries.