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JEREMY:
Hello and welcome to another episode of Eat This Podcast with me,
Jeremy Cherfas.

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ANNA:
The pat answer to how do you change people's diets for better health
is you tell them what to eat and they have to figure it out.

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What we've discovered is that for 2.8 billion people in the world,
that's not going to work.

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JEREMY:
That's Anna Herforth, a nutrition researcher at Tufts University in
Boston.

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I last spoke to Anna Herforth in March 2021, soon after, FAO, the
Food and Agriculture Organization, published a report

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on The Cost and Affordability of Healthy Diets Across and Within
Countries.

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Anna and her colleagues gathered the data to show that a healthy diet
was beyond the reach of almost 3 billion people around the

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world. Since then, the project has continued to gather and analyze
information on the cost of a healthy diet, and that's matured

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into an index that's tracked by the FAO and by the World Bank.

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And that index is beginning to have an impact on government policy.

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Anna Herforth and Will Masters, an agricultural economist at Tufts who
leads the food prices for nutrition team, were in Rome a few days ago

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for a workshop on the cost of a healthy diet.

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That's how I found myself on the terrace of the World Bank's offices,
high above the traffic on the Via Veneto, apologies for the noise,

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talking to Anna and Will and two of their colleagues, Oletayo
Adeyemi, who works with the Ministry of Agriculture and the Ministry

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of Planning in Nigeria, and Imran Choisa, Principal Statistician at
the National Statistical Office of Malawi and a data analyst for the

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project. I started by asking Anna Herforth about the origins of their
work.

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ANNA:
Originally, so we started back in 2016.

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We've been working on using food prices for nutrition, and the
impetus was looking at how the world defines food security, how the UN

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defines food security as access by all people at all times to
sufficient, safe, nutritious food to meet dietary needs for an active

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and healthy life.

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And when you think about what that means, that food security is
nutritious food to meet dietary needs, that really wasn't being

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tracked by the global indicators at the time of hunger and food
insecurity experience asked by questionnaires.

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And so we started with the idea of could we use food prices to
understand access to healthy diets?

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Can people actually go to the market and purchase a diet that is
being recommended to consume to meet their dietary needs by food-based

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dietary guidelines, sets recommendations around what people should
eat.

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Can they actually do that?

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Can they actually go to the market and do that?

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JEREMY:
But is that a question of what's in the market or is it a question of
can they buy what's in the market?

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ANNA:
It's both.

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It's both. But there's a lot of foods in the market.

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And when you, when people are being advised to eat a certain way, it
is a question of doesn't it or does it exist there?

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And do all the food groups that are recommended -- fruits,
vegetables, animal sourced foods in addition to the starchy staples?

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Are they present?

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but also what's the least cost that they would have to spend to
purchase those items and consume them?

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And can they afford it?

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JEREMY:
This idea of least cost for a nutritious diet assumes you kind of know
what the nutritious diet is, and you go to the market and you want to

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buy it. So how do you actually calculate the least cost for a
nutritious diet?

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WILL:
Yeah. So we have scientific consensus about what is a healthy diet
that comes from the convening of nutritional epidemiologists,

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nutrition scientists who know about biochemistry and the mechanisms
of human nutrition to identify what are the vitamins, minerals,

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macronutrients, protein that are needed in certain proportions for
metabolism and lifelong health.

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So those dietary guidelines are expressed in terms of food groups,
nutritionally defined, not defined the way you might for other

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statistics, but for nutritional statistics.

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We redefine items into food groups that meet these human needs.

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So identifying the quantities of each of these nutritional food
groups and then matching foods to their composition.

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To know that if you have a mango in a certain country, how big is
that mango?

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And what is its price per unit of fruit?

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What is its price per unit of fish?

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If it's dried fish or a big fish, you'd have very different
composition.

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Some fish have a lot of water, some have less water.

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So you'd want to be able to match each item to its nutritional
composition, and then use these software tools to compute the least

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expensive way of getting the compounds, the vitamins, minerals,
macronutrients that you would need for an active and healthy life.

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JEREMY:
But the the person at the market buying their diet doesn't do that
computation.

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So is this is this really a way of being able to compare countries?

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WILL:
What we're comparing is food systems, food systems that produce and
deliver these foods with their nutritional value or lack of

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value to people in often very remote places at lean seasons long
after harvest.

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And we're measuring the ability of the food system to actually do
that.

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Now, whether people choose those foods is a separate question, and a
big part of our project is to compare what people actually choose with

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what would be possible to buy.

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And that helps us to know why people aren't getting a healthy diet.

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Is it because of high prices?

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Is it because of low incomes, or is it because of the problem that
you can't see, taste, or smell the nutritional composition of food?

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And this is not something that people necessarily know.

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So we're trying to bridge these gaps between the cost of delivering
the food, the income people have for food, and the ability of people

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to make food choices that would lead to a lifelong health.

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JEREMY:
And these three different reasons why people are maybe not buying the
most nutritionally adequate diet they could, does it vary from

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place to place?

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And what does that ... What are the implications for how to tackle
the problems?

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ANNA:
It certainly does vary from place to place.

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You know, one of the big motivations in looking at access to healthy
diets, in terms of the economic cost in the market, is that coming

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from the field of nutrition, the pat answer to how do you change
people's diets for better health is you tell them what to eat and they

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have to figure it out.

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What we've discovered is that for 2.8 billion people in the world,
that's not going to work.

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Because if you tell someone that you should have half of the plate in
fruits and vegetables and a certain proportion of animal

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sourced foods and legumes and nuts and seeds to give them the
balanced diet in terms of, you know, nutrients and health protective

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components that they need, those elements of the diet are more
expensive than starchy staples, oils and fats and often

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sugar. And so what we see is that in a lot of places, the poorest
people are eating diets that are up to 75 to 80 percent

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from starches.

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And we know that that's not going to provide their dietary needs.

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And when you try to advise people who have severe income constraints
to just add more healthy foods, and you

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go to the market and you look at the prices, you understand
immediately why they can't do that.

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And so we don't need to just tell people that it's their
responsibility to figure out how to get those foods, but actually work

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with food systems to figure out how we could make all of those items
more available and more affordable.

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And then in some cases, removing income constraints.

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And this was what immediately happened in Nigeria when they started
measuring this indicator.

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JEREMY:
What a very nice cue.

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Thank you. Let's go to Nigeria.

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What did the numbers reveal about the cost of a nutritious diet in
Nigeria?

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TAYO:
So firstly, the numbers revealed that the cost of nutritious diets are
considered low by many people.

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Like by most policymakers, they look at the numbers and say, oh, is
it that low to consume a healthy diet?

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And they are a little bit skeptical when they see it, because it
looks a lot lower than what they spend on food.

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But then they realize that the baskets are also not the things they
would normally eat.

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But then I think what makes it very striking for them is then when
they compare those numbers to income and they realize that even though

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the numbers are low, like the cost of the healthy diet is low, a lot
of people, like a significant proportion of the population, cannot

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afford those low cost.

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And it's clear any way you look at it, whether through people's
expenditures or through the minimum wage or the average

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wages that people who work for the government are paid, then you
realize that people just cannot afford this low cost.

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And so it has been a very striking indicator for them because it sort
of like emphasizes

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that the malnutrition we have -- and we have a lot of it in Nigeria 
-- is that food security is a real issue.

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Before, when you say the numbers, people think, oh, okay, maybe they
can't eat this kind of food.

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Or when you say this number of people are poor, they say, oh, maybe
they can't buy fancy clothes.

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But when you give this very low number and you say this is the cost
of a healthy diet and you compare it to incomes and you say this many

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people cannot afford it, then it's clear to them that, okay, there is
a problem here.

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JEREMY:
So having recognized the problem, have they actually ...

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Has the government of Nigeria actually responded?

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And are they doing something about it?

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TAYO:
So in a ...

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so one of the things is that the cost of healthy diet has also been
increasing since like 2020.

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And so I mean, inflation has been going up and then the cost of
healthy diet has been increasing, but at a much faster rate than

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inflation. And so there has been a lot of pressure on the government
to increase wages.

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And so the government says, okay, if we want to increase wages, what
should we consider?

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And so the Bureau of Statistics that calculates the cost of healthy
diet, as well as the inflation indicators gave the government

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the consumer price index as well as the cost of healthy diets to make
the decision about where to put wages.

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And the cost of healthy diet was really a game changer, because when
the government first set a minimum wage, then the labor union said,

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but look, the cost of healthy diets is this amount.

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And even with this wage you are proposing, it's still going to be
very difficult for families to afford a healthy diet and a lot

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of other basic needs.

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And so based on the cost of healthy diets, they were able to
negotiate for a minimum wage that is more than twice what it used to

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be. So that happened this year, 2024.

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JEREMY:
And it's only just happened.

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What do you what do you think the impact will be overall?

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TAYO:
So I think it's hard to say.

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We know that when wages go up, some other things may also ...

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like other things may go up.

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So the implementation is just starting I think in a lot of places.

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It started in maybe August, September.

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So, we are going to have to wait a while to see what the full impact
is going to be, but at least it's ...

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Important conversations are starting to happen, and we are starting to
see policy making in line with true welfare of the

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people.

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JEREMY:
So, okay, you put up you put up the minimum wage so people can afford
a nutritious diet, and then the price of food goes up.

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WILL:
Yes, there's a big challenge in trying to make sure that food in
particular stays at a level that's relatively low compared to things

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that are needed for other purposes, but that without health you can't
take advantage of education, you can't take advantage of other

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opportunities without health.

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So this basic need is something that we're able to shine a light on
and try to ensure that people orient policies

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towards lower cost foods.

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One big issue is whether the low cost options are, in fact, kept
available around the country throughout the year, in contrast to

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more luxurious options, and one of the big problems is that often
decision makers are living in a bit of a bubble, and they tend to

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focus on nicer foods and being sure that there are apples available,
that there are more luxurious products available, and just ensuring

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that the basics are present is something that's very important for
low income people in particular.

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JEREMY:
Now that reflects exactly what Tayo was saying about, you know, it
being a wake up call when they actually see the numbers.

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As a general rule, is it more important to increase incomes or
decrease the price, or reduce the price, of the more nutritious

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foods?

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WILL:
The most important fact about this new kind of measurement is that
it's new, and that we've only just begun to accumulate enough

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observations in enough different places to begin to even explain why 
there's the variation we observe and what the consequences of that

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variation are.

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I would say initial indications are that much of the undernutrition
in the world is truly due to low incomes, but there is

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still a lot that's due to the high cost of production and
distribution of these nutrient rich foods that are protective against

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metabolic diseases through the life course and also bring nutrients to
avoid micronutrient malnutrition, the vitamin A deficiency, the

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anaemia that is still very prevalent in the world.

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And that those ...

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The costs of those foods can come down quite a bit with agricultural
investments.

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That would matter a lot.

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But there is this problem of food choice that it's so hard to know
what is healthy or isn't healthy when companies are marketing

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healthful attributes that aren't really healthy and so forth.

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So we see quite a lot of food choice mattering still.

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So prices, incomes, and food choice all matter a lot, but it's just
early days on understanding how much.

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JEREMY:
Countries are at different stages of making use of the project and,
beginning to, to, to influence policy.

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So in Malawi, how how has the project influenced what you've been
doing in Malawi?

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IMRAN:
So, in this project in Malawi, we started last year and we've

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been doing some analysis using the historical data, and we've got the
results.

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We've conducted one of the stakeholder consultation meetings and
where we saw the demand from the

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stakeholders about this kind of indicator.

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So we are still in the process of getting these numbers published, as
well as to engage the

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relevant policy holders so that they can promote some of the policies
based on the results that we are getting.

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JEREMY:
My understanding is that Malawi is actually more dependent, more ...

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There are more smallholder farmers who are sort of subsistence
farmers compared to Nigeria.

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Does it make much of a difference when people are mostly growing food
for themselves and have a small surplus to sell at the

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market, versus a more market oriented economy for food?

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Do you think it is a big difference going to show up there?

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IMRAN:
I think there is a big difference.

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But then, you know, in Malawi, the agriculture mostly depends on the
rainfed.

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It's rainfed agriculture.

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So the availability, the supply of the food items is seasonal,
mostly.

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And even for those subsistence farmers that purely depend on farming
to get their food, sometimes due

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to the rains and some issues of seasonality, we find that they are
not able

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to consume the food they produce throughout the year.

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So in a way, they still have to find a way to purchase these food
items from the market.

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And the prices  for the food in general is so volatile in Malawi
because of these issues of seasonality.

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We have in the recent past, from around 2019, 2020, we have been
having some economic shocks.

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We recently have the cyclones and most of the fields were washed away
when the

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farmers had already planted their, you know, their crops.

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So this has forced a lot of farmers to find other means of getting
their food.

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So this is basically from the markets or maybe from, you know, other
donors who might come, some relief items and so on.

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So, yeah.

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Yeah, Malawi is mostly ...

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People produce their own food.

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But then due to these economic shocks, we still need to also get
these foods from the market.

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ANNA:
I wanted to add something based on what you're saying about
seasonality.

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This illustrates exactly why it's important that countries are also
calculating this indicator of cost of a healthy

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diet within the country, because the organization, the the national
statistical organization where Imran is

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working with the price data, is collecting prices in all the seasons.

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Every month, they're collecting new prices so they can see what's
happening over the year in different seasons, in different parts of

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the country. Who can't access a healthy diet in the market, when and
where.

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And this is something that in the global monitoring of this
indicator, we can't see.

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FAO tracks this indicator annually for every country, but the level
of data that's available is at national level -- you can't see within

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a country what's happening -- and for the entire year, so you can't
see what's happening seasonally.

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And so for these kinds of potential informing potential policy
actions or programmatic responses, the data

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that Imran's organization is constantly dealing with is the data that
will show when and where the problem is.

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JEREMY:
And is that the same in Nigeria?

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Are you collecting data monthly from every region?

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TAYO:
Yes. So the National Bureau of Statistics collects data for rural and
urban for 36 states as well as the Federal Capital Territory.

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So 37 locations, and this is collected monthly.

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And the cost of healthy diet is calculated monthly for these 37
strata.

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So it helps them to see where costs are high and where they are low.

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And so we're trying to understand better what might be the reason for
the differences.

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JEREMY:
That sounds like something all countries should be doing.

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ANNA:
Well, they are.

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And that's why this project is leveraging what already exists.

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So not every country is calculating the cost of a healthy diet.

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These are, Nigeria and Malawi are, two, you know, pioneering
countries in that regard.

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But all countries are collecting monthly prices for their consumer
price index.

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And so the beauty of the indicator is that there's no new data
collection that needs to happen.

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The data is already there in all countries, which food prices are a
very important part of inflation monitoring.

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So the food prices are already there.

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It's a matter of analyzing those prices to understand the cost of a
healthy diet that consumers are facing in the market.

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JEREMY:
This sounds so easy and so efficient.

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Can you just give them a software package and they find out what
their cost of a healthy diet is.

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IMRAN:
Yeah, exactly.

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So as Anna said, we are already collecting this kind of data.

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So there is no additional effort in collecting the data we already
have that we are using for the CPI computation.

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So the Food Price for Nutrition project developed some tools, some
metrics that have been

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standardized. And we are using these tools, you know, just to
customize them so that we can use for our case, like

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for Malawi, make sure that we organize our data and feed the data
into that system.

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And already the system has the formulas built.

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So once you update the numbers, you customize your data to fit into
this, once we do

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all these processes, we feed the data into the system.

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We feed the ...

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We do the food matching and yes, yeah, we have the numbers
automatically.

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JEREMY:
And are lots of countries coming to you for advice as to how they
should do this?

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IMRAN:
Not yet.

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Maybe Nigeria, because they are already advanced.

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But yeah, we ...

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since we are one of the pioneering countries in this project, we are
ready to assist whatever country wants

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to be part of this project.

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JEREMY:
Will, let me ask you ...

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I last spoke to Anna in 2021 when the first big tranche of data came
out, I think.

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Let's do time travel, go forward ten years.

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What has happened to the cost of a nutritional diet.

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WILL:
So we certainly hope, we believe, and I think it is truly possible
that in ten years there would be, first of all, global development

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goals that specify each person should actually have access to a
healthy diet that meets the national dietary guidelines of their

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country, and that those goals get acted upon in ways that begin with
measurement, that continue through interpretation and

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use of the data to guide investments in agriculture, which currently
do not focus on these healthier foods and certainly do not focus on

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the low cost versions of the food.

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People who are agriculturalists want farmers to become richer, so
they tend to focus on the needs of richer customers, and the low cost

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options are often neglected.

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Also, fruits and vegetables are often neglected.

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Simple dairy products -- the low cost yogurts -- are often neglected.

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And when we shine a light on them, we can see that there are
opportunities to meet the needs of the large majority of people who

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currently are often neglected, because for each customer, it's a
relatively low income.

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But with identifying the need, the opportunity, we think we can
actually achieve this goal.

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If we identify it, we measure it and communicate clearly what's at
stake.

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JEREMY:
It seems to be, from what I've heard, that the project is kind of
running along smoothly.

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It needs to be taken up in more detail by some, by some places, many
places.

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But basically gathering the data, analyzing the data, the kinds of
recommendations you might get out of the

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data -- that seems to be chugging along.

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So what now?

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ANNA:
Well, what started as a project has become a global indicator.

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So it has moved out of the phase of really being called a project at
this point.

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It's a global indicator that's tracked by the United Nations Food and
Agriculture Organization, with key data inputs from the World Bank.

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And these two institutions are publishing the indicator for all
countries around the world every year.

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And this information has changed the discourse on what's talked about
in terms of access to food.

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It's not just access to calories.

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It's not just the poor need more starchy staples.

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It's everyone needs access to healthy diets.

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And so that has become embedded in the discourse about food as far as
countries own

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data systems and practices.

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This is, I think, the next frontier, of moving the conversation and
the potential actions into countries, and what has happened in Nigeria

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and Malawi and some other countries who have come together here in
Rome to share experiences, illustrates how that's starting to happen.

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And the next step, I think, there does need to be kind of a global 
system where the support to use

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the software tools that Imran was referring to, to analyze the data
and, you know, the use of the data

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within countries, is ...

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That's the next step is to facilitate that process within countries
around the world, which has only just begun.

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JEREMY:
Just one thing. I mean, the SDGs, the Sustainable Development Goals.

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We're at, what, six years, five years away from ...

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Some of them will happen. Some of them won't happen.

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Is the cost of a nutritious diet, is that the next big ...

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Is that the next big global goal?

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Is that the one for 2040?

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WILL:
We certainly believe that this is the kind of goal that governments
can embrace.

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It's something that is achievable.

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All of humanity is about setting aspirational goals for ourselves,
individually, our families.

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This is an aspirational goal.

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We're not there yet, but it is something that can be done.

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So I certainly believe that governments can come around to seeing
this as a measurable goal that is achievable, that is aspirational --

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because we're not there yet -- and that could be a successor, a part
of the successor development goals, whatever they might be after 2030.

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Things that could be done in this these coming decades.

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JEREMY:
Will Masters rounding out our conversation on the cost of a healthy
diet.

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My thanks to him, to Olutayo Adeyemi from Nigeria and Imran Chiosa
from Malawi, and to Anna Herforth.

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I'll put links to the Food Prices for Nutrition team and some of the
websites that make use of their data in the show notes at EatThis

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podcast.com.

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I should say I was particularly struck by one thing.

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Anna said that most countries don't need to collect any extra data.

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They do need to do some extra analysis, but the insights that offers
can make a real difference to whether people can afford to eat a

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healthier, more nutritious diet.

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A quick reminder that there's a transcript you can download, and one
that lets you read along as you listen, if your podcast app supports

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that, both thanks to the generosity of supporters of the show.

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And if you enjoy this podcast, please tell a friend and leave a
rating or review wherever you get your podcasts.

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It all helps to spread the word.

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For now though, from me, Jeremy Cherfas and Eat This Podcast, goodbye
and thanks for listening.