MOBILISING THE FOOD CHAIN FOR HEALTH Workshop 25-26 OCTOBER, 2012, OECD CONFERENCE CENTRE, PARIS...

MOBILISING THE FOOD CHAIN FOR HEALTH

Workshop

25-26 OCTOBER, 2012, OECD CONFERENCE CENTRE, PARIS

Prakash Shetty and Josef Schmidhuber

Th

e N

utr

itio

n T

ran

siti

on

Overview

• Part I: What makes a healthy diet?• Part II: What is the nutrition transition?• Part III: NCDs: The extent of the problem

and its main manifestations• Part IV: Nutrition transition, NCDs and the

key drivers– Ageing populations, urbanization and income growth– Phenotypic and genotypic predisposition– Agricultural policies?– … many more!

Ove

rvie

w

http://www.fao.org/docrep/005/ac911e/ac911e00.htm

1. What makes a healthy diet? T

he

Nu

trit

ion

Tra

nsi

tio

n

Dietary Intake Ranges (1)(as a share of total energy intake)

Dietary Factor Recommendations (WHO/FAO)

Total Fat 15 - 30%

Polyunsaturated FA 6-10 %

Saturated FA <10 %

Trans FA <1 %

Total Carbohydrate 55 – 75 %

Free sugars* <10 %

Protein 10 - 15%

* “Free sugars” refers to all monosaccharides and disaccharides added to foods, plus sugars naturally present in honey, syrups and fruit juices

1. What makes a healthy diet? T

he

Nu

trit

ion

Tra

nsi

tio

n

Dietary Intake Ranges (2)(in g or mg/person/day)

Dietary Factor FAO/WHO Recommendations

Cholesterol < 300 mg/day

Sodium chloride(sodium)

<5 g/day(<2 g/day)

Fruits and vegetables > 400 g per day

Total dietary fiber/Non-starch polysaccharides (NSP)

(>25 g, or 20g/d of NSP) from whole grain cereals, fruits, and

vegetables

1. What makes a healthy diet?

http://www.fao.org/docrep/005/ac911e/ac911e00.htm

Th

e N

utr

itio

n T

ran

siti

on

Overview

• Part I: What makes a healthy diet?• Part II: What is the nutrition transition?

Ove

rvie

w

Th

e N

utr

itio

n T

ran

siti

on

The shape of things to come ...The Economist, December 2003

Th

e N

utr

itio

n T

ran

siti

on

More fat and more saturated fatT

he

Nu

trit

ion

Tra

nsi

tio

n

Th

e N

utr

itio

n T

ran

siti

on

More Cholesterol T

he

Nu

trit

ion

Tra

nsi

tio

n

Th

e N

utr

itio

n T

ran

siti

on

More sugar, mostly hiddenT

he

Nu

trit

ion

Tra

nsi

tio

n

Th

e N

utr

itio

n T

ran

siti

on

Overview


and its main manifestations

Ove

rvie

w

AT2050/80: provisional nutritional outcomes (global averages/aggregates)

undernourished% of population

with kcal/person/day

obese

% million >2700 >3000 % million

2005/07 13 844 57 28 9 570

2050 4 330 91 52 15 1400

2080 2 150 98 66 21 2000

Th

e N

utr

itio

n T

ran

siti

on

Copyright restrictions may apply.

Yach, D. et al. JAMA 2004;291:2616-2622.

Deaths Attributable to 16 Leading Causes in Developing Countries, 2001

Th

e N

utr

itio

n T

ran

siti

on

Global estimates of Hunger and Childhood malnutrition

(UNICEF 2005)

Almost 870 million people are chronically undernourished (FAO, 2012)

Childhood Malnutrition:

Underweight Stunted Wasted

Low birth weight

Developing Countries:

27 % 148 million

31 % 175 million

8 % 44 million

17 %

Th

e N

utr

itio

n T

ran

siti

on

Unicef 2005

Micronutrient malnutrition

MicronutrientMalnutrition

Vitamin A deficiency

Iron Deficiency

Iodine deficiency

Global Estimates:

100 -140 million children 2.0 billion women (96 million pregnant)

740 million

(Micronutrient Initiative Report 2001)

Th

e N

utr

itio

n T

ran

siti

on

Burden of Disease attributable to Iron Deficiency

(expressed as percent DALYs)

Th

e N

utr

itio

n T

ran

siti

on

Overview


and its main manifestations• Part IV: Nutrition transition, NCDs and the

key drivers– Ageing populations, urbanization and income growth– Phenotypic and genotypic predisposition– Agricultural policies?– … many more!

Ove

rvie

w

Ageing populationsT

he

key

dri

vers

19731975

19771979

19811983

19851987

19891991

19931995

19971999

20012003

20052007

0

5

10

15

20

25

30

35

40

45

Robust income growth for the last 5 decades

High income RoW

GD

P, T

rilli

on U

S$ (2

004)

Th

e ke

y d

rive

rs

Source: World Bank

GDP Growth to continueG

DP,

tril

lion,

$20

04 percent per annum

Developing GDP (left axis)

Developing Rate (right axis)

High-Income GDP (left axis)High-Income Rate (right axis)

Th

e ke

y d

rive

rs

Source: World Bank

19501955

19601965

19701975

19801985

19901995

20002005

20102015

20202025

20302035

20402045

2050 —

1.00

2.00

3.00

4.00

5.00

6.00

7.00

Urbanization to further accelerate over the next 40 years

Rural Urban

Billi

on p

eopl

e

Source: UNPD, 2011

Th

e ke

y d

rive

rs

UrbanizationChanging food marketing chains and food habits• Access of metropolitan areas to international

food markets• Formalization of the food chain, supermarkets • Opportunity costs of food preparation: No time

to prepare food, limited time to eat• Convenience and fast food (salt, fat, sugar)

Expending calories• Sedentary lifestyles (public and private

transportation, lifts, piped water, TV)

Th

e ke

y d

rive

rs

Rural - Urban differences in Obesity prevalence

0

5

10

15

20

25

Vietnam China Indonesia

PR

EV

AL

EN

CE

( %

)

Rural

Urban

Th

e ke

y d

rive

rs

Urban-rural difference in chronic disease risk in developing countries

Urban (%) Rural (%) Reference

NIDDM prevalence

8.2 2.4 Ramachandran (1998)

CHD prevalence

46.1 5.0 Chadha et al. (1990)

Cancer incidence

118.8 57.6 Gopolan (1997)

Source: Shetty, P. in Macbeth and Shetty

Th

e ke

y d

rive

rs

Genotypic and phenotypic predisposition

• Unmasked by urbanization, sedentary lifestyles and excess food consumption

• Thrifty gene (Pima Indians, South Pacific)• Barker hypothesis and epigenetic effects

Th

e ke

y d

rive

rs

Agricultural policies?

The CAP?

OECD support policies more generally?

What about biofuel policies?

Th

e ke

y d

rive

rs

Principal policy effects of the CAP2001/03

MILLION € €/PERSON

1. Taxes

Taxes through higher prices than world prices

-51,904 -136.8

Other taxes on consumers -698 -1.8

2. Subsidies

Subsidies from taxpayers to consumers 3,762 9.9

Excess feed cost (not relevant as a food tax/subsidy)

570 1.5

Net effect (total tax) -48,271 -127

Source: own calculations (JS) based on OECD

Th

e ke

y d

rive

rs

Price tax effect of the CAP by Commodity

(main commodities only)1986-88 1994-96 2001-03

Total(million €)

per person(€)

Total(million €)

per person(€)

Total(million €)

per person(€)

Oilseeds 0 0.0 0 0.0 0 0.0

Eggs 900 2.7 262 0.7 0 0.0

Wheat 6254 18.4 1343 3.7 157 0.4

Rice 377 1.1 317 0.9 180 0.5

Potatoes 619 1.8 900 2.5 444 1.2

Coarse grains 7043 20.7 2703 7.4 559 1.5

Sheep 2497 7.4 1376 3.8 1113 2.9

Sugar 2699 7.9 2100 5.8 2739 7.2

Poultry 2950 8.7 3995 11.0 3179 8.4

Pork 4473 13.2 2973 8.1 4401 11.6

Beef 10208 30.1 7205 19.8 10470 27.6

Milk 16667 49.1 17278 47.4 16373 43.2

Total 54686 161 40452 111 39615 104


Th

e ke

y d

rive

rs

Consumer subsidies through the CAP

Transfers from EU Taxpayers to EU consumers (million Euros)

1986-88 1994-96 2001-03

million Euros

Total 4387 4146 3762

Cereals 310 286 249

Oilseeds 32 0 0

Sugar -361 -138 248

Sugar storage levies (net) -65 -24 99

Sugar chemical industry levies (net) 1 67 157

Milk and butter 2169 1549 1035

Olive oil 388 365 26

Cotton 723 1100 874

Fruits and vegetables 1126 986 1330


Th

e ke

y d

rive

rs

CAP Consumer subsidies for milk

1986-88 1994-96 2001-03

(million Euros)

Milk and butter, total 2,169 1,549 1,035

Other measures relating to butterfat 232 645 454

School milk 165 130 77

Aid for SMP for use as feed for calves 901 438 246

Aid for liquid skimmed milk for use as feed for calves 112 24 0

Aid for SMP for use as feed for animal other than calves 0 0 0

Aid for liquid skimmed milk for use as feed for animals other than calves

179 0 0

Aid for skimmed milk processed into casein 580 311 258

Aid for powdered milk with 10% fat for use as feed for calves

0 0 0

Other Aid (milk) 0 0 0


Th

e ke

y d

rive

rs

Food taxes?

Th

e ke

y d

rive

rs

• Through agricultural policies• Through direct food taxes

Vertical price transmission:The impact of the CAP with high margins

T

T

Pborder

Pmarket

Pmarket+T

Pconsumer

Pincentive

Pconsumer+T

PSE-M

PSE-R

100

150

200

250

300

350

400

450

PSE-M/CSE-M

PSE-R/CSE-R

Pborder

Pmarket

Pincentive

Pmarket-2

Pconsumer

Pconsumer-2

T

T

M1 = M2

+34$=20%

+34$=10%

Source: Schmidhuber and Britz, 2002

US$/t

Th

e ke

y d

rive

rs

Food value chain in the EUEU-15, 1996, 1.25 €/$ x-rate

(Data based on OECD and World Bank, own calculations)

0

200

400

600

800

1000

1200

1400

Year=1996

bil

lio

n U

S$

1996

Value of consumption at world prices, primary products =US$ 139 billion

CAP - CSE tax on consumption = US$ 48 billion

Margin/value added for marketing, processing, etc = US$ 780 billion

Value of final food expenditure = US$ 1014 billion

Fo

od

tax

es:

effi

cien

cy a

nd

eff

ecti

ven

ess

Vertical price transmission – the empirical evidence

How elastic is food demand?

Fo

od

tax

es:

effi

cien

cy a

nd

eff

ecti

ven

ess

Impacts of an (ad valorem) tax on food with elastic and inelastic demand

TTPo

Po

P1

P1

(Rich consumer) (Poor consumer)

q1 q0 q1 q0

Di

Dd

Si

Sd

Inelastic demand Elastic demand

D’dD’i

Fo

od

tax

es:

effi

cien

cy a

nd

eff

ecti

ven

ess

Policy instruments: Effectiveness of food taxesF

oo

d t

axes

: ef

fici

ency

an

d e

ffec

tive

nes

s

Impacts of a tax on “food” on “overweight/obesity”

TPo

BMI0P1

Rich consumer (IC)

Q1=DES1

Di

Si

Food (input)

D’i

body weight (output)

BMI1

DES0DES1DES DESQo=DES0Fo

od

tax

es:

effi

cien

cy a

nd

eff

ecti

ven

ess

Food taxes: some pros and cons

– Higher farm prices ineffective means to change final consumer prices (high margins in vertical price transmission).

– Low price elasticities for food demand make food taxes in general ineffective in reducing consumption.

– Regressive on consumers with high calorie needs.– Untargeted, unfair: all consumers bear the price of higher food

prices while only the obese/overweight cause the external costs (violates the “polluter pays principle”).

+ But low elasticities mean high tax revenues which could be used for nutrition education, prevention, and other measures.

+ Food taxes can be effective, where there are healthy substitutes (e.g. low-sugar soft drinks); high elasticity of substitution would require only a small tax on unhealthy food of a small subsidy on the healthy food.

No general food tax, but specific taxes on unhealthy foods possible.

Part of a policy mix but not a stand-alone measure.

Fo

od

tax

es:

effi

cien

cy a

nd

eff

ecti

ven

ess

Conclusions

• Emerging epidemic of obesity (and its co-morbidities) not confined to the developed world

• Determinants of the emerging epidemic of global obesity are complex and include macro and micro level drivers and individual and environmental factors

• Strategies that are developed to reduce the global burden of obesity will need to address a complex range of individual and environmental determinants.

Thank you

Conclusions and outlook1. EU diets have become increasingly unhealthy, the quality of the

Mediterranean Diet is gradually deteriorating.• The EU diets are too rich in calories, fat, sugar, cholesterol and saturated fats.• Dietary fibre as well as fruit and vegetable consumption have increased over

time, but some countries still show deficits.• Consumption of polyunsaturated fats has increased, but largely through a

widening of the ω-6/ω-3 ratio.• The total glycemic load of the EU diets has increased with carbohydrate

consumption, but remained low compared to NENA countries.• There has been a growing convergence in diets, new member countries move

towards EU-15 diet, albeit some country specific features remain.2. Overall, CAP provides a net tax on food consumption, albeit some subsidy

elements are important.3. As a tax on primary consumption, the demand curbing effects of the CAP

remain limited; CAP effects are to be seen against: (i) low vertical price transmission; (ii) high margins for processing and marketing; and (iii) low demand elasticities.

4. Taxes on final consumption can be more effective, but only where healthy substitutes exist.

5. Food taxes on inelastic demand can be used as a revenue source for more effective measures (education, etc.)

6. No single policy measure likely to be sufficient, need for an appropriate policy mix.

Co

ncl

usi

on

s an

d O

utl

oo

k

Fast food, soda and obesity

Are diets converging and how to measure convergence?

The Consumption Similarity Index (CSI)

95

1, 2

11

i k

ik

j

ijkj Cal

Cal

Cal

CalCSI

where i=1 to 95 food items of FAO’s SUA data base;

Calij and Calik are the calories from individual products i in country k and j;

Calj and Calk is the total calorie availability per person in country j and k.

Th

e N

utr

itio

n T

ran

siti

on

Towards an increasingly homogenous diet?T

he

Nu

trit

ion

Tra

nsi

tio

n

Th

e N

utr

itio

n T

ran

siti

on

Domestic-to-international distortions

EU prices to international prices (ratios)

Internal distortions of relative prices

(relative to EU wheat prices)

1986-88 1994-96 2001-03 1986-88 1994-96 2001-03

Wheat 2.14 1.14 0.98 1.0 1.0 1.0

Rice 2.43 1.84 1.32 1.1 1.6 1.3

Coarse grains 2.33 1.41 1.05 1.1 1.2 1.1

Oilseeds 1.00 1.00 1.00 0.5 0.9 1.0

Potatoes 1.17 1.15 1.10 0.5 1.0 1.1

Milk 2.76 2.14 1.84 1.3 1.9 1.9

Beef 2.25 1.63 2.54 1.1 1.4 2.6

Pig meat 1.38 1.17 1.25 0.6 1.0 1.3

Poultry 1.79 2.07 1.55 0.8 1.8 1.6

Sheep 2.86 1.59 1.36 1.3 1.4 1.4

Eggs 1.40 1.22 1.04 0.7 1.1 1.1

Sugar 3.32 2.13 2.75 1.6 1.9 2.8

The CAP distorts relative prices –

both vis-à-vis world markets and within the bundle of consumption goods

Th

e ke

y d

rive

rs

Global prevalence of Vitamin A Deficiency

Th

e N

utr

itio

n T

ran

siti

on

MOBILISING THE FOOD CHAIN FOR HEALTH Workshop 25-26 OCTOBER, 2012, OECD CONFERENCE CENTRE, PARIS...

Documents

Transcript of MOBILISING THE FOOD CHAIN FOR HEALTH Workshop 25-26 OCTOBER, 2012, OECD CONFERENCE CENTRE, PARIS...