Snacks and the city: the malnutrition cocktail
Global Panel Member Tom Arnold, Dr Sania Nishtar, Co-Chair of the WHO High-Level Independent Commission on NCDs, and Sudhvir Singh, Policy Director at EAT, explore the state of urban food environments, emerging eating habits, and examples to invert the trend towards the production and promotion of healthier diets.
City living is often glamorized across the media, characterized by prosperity and cosmopolitan sophistication. But the truth is that rapid urbanization, particularly in Africa and Asia, is adversely affecting diets and food systems, which is leading to health, social, and economic inequality and environmental degradation.
As we write this article, we reflect on a significant demographic anniversary. Around this time 10 years ago, the world’s urban population surpassed the rural population for the first time. And it continues to rise. Roughly two-thirds of the global population is projected to be urban by 2050, equivalent to the Earth’s inhabitants in 2004. Africa and Asia will have 2.5 billion more urban residents within three decades.
The influence of a rapidly growing urban population on the environment, economy, sanitation, health, and national infrastructure is well-reported. Less well-reported, though, is the dramatic impact that urbanization is having on our diets and hence on food systems. Within cities, lifestyle pressures and the food environment are markedly different from rural areas.
Urban consumers who are not among the wealthy elite frequently rely on cheap and convenient street foods, which are often low in nutrient density and high in fat, sugar, and salt. A review of 23 studies in sub-Saharan Africa showed daily energy intake from street foods ranged from 13 percent to 50 percent in adults and 13 percent to 40 percent in children. In Nigeria, adolescents obtain 40 percent to 70 percent of their food from street vendors.
Employment opportunities are also more varied in urban areas. While this is undoubtedly positive, it does also come with its challenges. As people get wealthier, the consumption of high-quality diets can increase. However, the consumption of unhealthy foods tends to increase even more. Working breastfeeding mothers often have little to no workplace childcare support. As such, they have to weigh the benefits of breastfeeding with the consequence of lost income.
Supermarkets are a key feature of urban environments, providing a wide variety of foods. However, evidence suggests that low-income households in many parts of the world are heavily dependent on ultra-processed and packaged foods in supermarkets, rather than fresh fruits and vegetables or dairy.
People in urban environments are also much more exposed to marketing and advertising. To put this into perspective, food and beverage companies accounted for 17 percent of all global media spending in 2012. Just a few large multinational food companies spent US$6.21 billion in 2014, equivalent to around 65 percent of the entire United Kingdom overseas aid budget.
As a result, we are seeing urban populations in low and middle-income countries presented with a cocktail of malnutrition. They concurrently lack adequate calories, lack sufficient micronutrients, or suffer from being overweight or obese with associated diet-related, non-communicable diseases. One survey of low-income households in Nairobi in 2013–14 showed that 41.5 percent of children were stunted and 74 percent were anemic, while 29 percent of women were overweight.
It is perhaps in the sale and marketing of unhealthy ultra-processed snacks where the private sector can have the most influence. Between 2000 and 2013, sales of ultra-processed food and beverage products in all Latin American countries increased by 48 percent. The recent Global Access to Nutrition Index 2018 revealed that less than one-third of the commercial food products available are classified as healthy. Although often blamed for a lack of social responsibility in producing and marketing these foods, from a commercial aspect one can understand why private sector vendors in formal and informal markets prefer these items, given their safety and long shelf life relative to fresh produce.
That said, examples where public-private partnerships are delivering healthy diets to vulnerable groups do exist.
The Makati Vendors Programme of the City, which was started in 1992, involves 760 Philippine street vendors, most of whom are women. They sell their cooked food, which is based on local products (rice and vegetables), in the vicinity of schools, bus stops, and stations. The program aims to provide the urban poor of Makati with an alternative source of income and encourages cleanliness and hygiene at the point of sale, while more likely to provide healthy alternatives to ultra-processed foods.
The EAT and C40 Food Systems Network, which includes 40 cities working together on integrated food system strategies and projects, also provides examples of innovative approaches that can be scaled. The Grab Some Good collaboration between Toronto Public Health and a range of nonprofit and private sector organizations brings healthy food into food deserts and food swamps in Toronto, Canada. It uses novel supply and distribution chains, such as pop-up markets in subway stations, and encourages small store owners to sell more healthy snacks.
In Mexico City, Mexico, the Community Dining Rooms program is a collaboration between the local government, academic institutions, civil society, and the private sector. It provides daily access to nutritious meals at affordable prices. The dining rooms are located in marginalized areas and reduce the number of citizens suffering from hunger.
Unfortunately, examples like these are too few, and their coverage too low. This is why the public sector must do more to provide the right mix of policy regulations and incentives for the private sector, as well as drive consumer demand for healthy diets. Producing healthier food doesn’t mean less profit; the private sector has demonstrated in the past that it is capable of using its considerable innovative talents and marketing power to provide foods for better nutrition and health.
High-quality diets in urban areas are as important as clean water, hygiene, and sanitation. What’s more, the complexity of urban environments and the diversity of the populations they serve present a unique opportunity for policymakers to think outside the box. They must seek to harness new technology, build new cross-sector relationships, catalyze the innovative power of young entrepreneurs, and use the high density of social media and commercial networks.
Let us look to a future, building on the New Urban Agenda, to create urban environments where the only snacks in the city will be healthy and sustainable ones.