IFPRI ISSUE BRIEF | JUNE 2024 Consumer Preferences Matter for Transforming Food Systems for Sustainable Healthy Diets Evidence from Rural Bangladesh Olivier Ecker, Andrew R. Comstock, Alan de Brauw, Xinshen Diao, and Md. Ruhul Amin Talukder C urrent food systems fail to provide sustainable healthy diets for everyone. Globally, about 3.1 billion people — or 42 percent of the world population — are unable to afford a healthy diet; most of them live in the global South (FAO et al. 2021). Poor quality diets are the leading cause of all forms of malnu- trition and common noncommunicable diseases (Afshin et al. 2019; Willett et al. 2019). At the same time, current food system activities are associated with substantial environmental degradation and biodiversity loss and are responsible for about 28 percent of total anthropogenic greenhouse gas emissions (GLOPAN 2020). While there is broad consensus that food systems transformation is urgently needed to achieve sustainable healthier diets (FAO et al. 2021; Webb et al. 2020), it is less clear what policies and actions can bring about change effectively KEY MESSAGES • Food system transformation strategies rely on consumer demand response for achieving sustainable healthy diets. • However, food consumption patterns and consumer preferences are often not well understood in many countries of the global South. • Bangladesh, a country in the take-off stage of agrifood system transformation, has experienced improvements in diet quality but also an increasing incidence of overweight, with faster increases in rural than urban areas. • Rural consumer demand is driven by strong preferences for animal- source foods, while the demand for sugar and highly processed foods increases faster than total food demand when income rises. • Agricultural value chain development can be an important policy instrument for improving household diet quality but can also lead to undesirable dietary change if food consumption incentives conflict with nutritional needs. at large scale, and what their potential dietary impact is at the population level. In considering how to bring about broad dietary improvements, we start from a consumer focus within the food system (IFPRI 2024). Two of the most important factors shaping consumer food demand and diet quality are changes in relative prices and changes in real income. This brief focuses on demand responses to price and income changes among rural households. Changes in relative prices will affect consumer demand patterns, but there is a lack of understanding about the responsive- ness of consumer demand to price changes in specific settings. Increases in income can drive up demand not only for more nutrient-dense foods but also for more heavily processed foods (Ruel and Alderman 2013). Consequently, if the policy goal is to improve diet quality, it is important to understand how demand for different foods is affected by changes in income for different types of consumers in different countries. Agriculture and the agrifood system (AFS), including all activities both upstream and downstream of agricultural production, are linked closely to food consumption and subsequent diet quality in most low- and middle-income countries (LMICs). As a result, agriculture and agricultural policies are pivotal for transforming current food systems and improving diets in the these countries, especially in their rural areas. Agricultural policies, and many other AFS-related policies, aim to transform food systems from the supply side and improve diets by increasing food availability and access, and therefore potentially changing relative prices and incomes. However, these policies can work both ways — they can foster dietary improvements by making nutritious foods more affordable but can also contribute to poorer diet quality by facilitating overconsumption of one food group (for example, staple foods) at the expense of other, under-consumed food groups (such as pulses and vegetables), or can increase consumption of unhealthy, ultra-processed foods. This brief highlights the importance of understanding changes in food consumption patterns, as a baseline for developing effective food system transformation strategies, and also consumers’ food preferences, as crucial factors for achieving desired dietary change. The analysis focuses on Bangladesh — a country that has already experienced rapid, early-stage food system transformation and achieved commendable progress in reducing severe food insecurity and widespread malnutrition — and, in particular, on shap- ing the food demand of its rural population. Bangladesh is an interesting case study country, because its recent food system transformation track record may provide important insights for other LMICs in South and Southeast Asia that are entering a phase of accelerated food system transformation. As in many other countries in the region, Bangladesh’s rural population still accounts for most of the total population (with an estimated 68 percent in 2022; BBS 2022), despite the country’s rapid urbanization. We first review the transformation of Bangladesh’s national AFS over the decade between the global food price crisis in 2008 and the onset of the COVID-19 pandemic, and outline new national food policy chal- lenges that emerged within this transformation. We then discuss the results of an in-depth analysis based on data from a representative household panel survey, which tracked individual households’ food consumption in rural Bangladesh over three survey rounds between 2011 and 2018. After describing household dietary changes observed in the data, the analysis turns to an examination of long-term consumer preferences for different foods and related food consumption responses to price changes, as indicated by econometrically estimated income and price elasticities of food demand. The revealed patterns of consumer behavior not only help to explain rural dietary change and AFS growth in the recent past but also allow us to make inferences about future AFS growth and prom- ising transformation strategies in Bangladesh. Bangladesh’s Food System Transformation and New Food Policy Challenges The rapid transformation of Bangladesh’s AFS between 2009 and 2019 occurred in conjunction with a rapid structural change in the entire economy (Diao et al. 2023). (The AFS encompasses both primary agriculture and all activities in related sectors along the value chain, such as those involved in sourcing production inputs and moving and transforming agricultural products before they are consumed.) Over this period, the gross domestic product (GDP) of the national AFS grew much faster than the agriculture sector alone, with an average annual growth rate during the pre-COVID decade of 5.4 percent compared with 3.5 percent growth in primary agricul- tural GDP. Hence, AFS growth was primarily driven by growth in its off-farm components, including domestic agricultural input production, agricultural trade and transport, agro-processing, and food services, amount- ing to 7.7 percent (with agro-processing growth reaching ConSumeR PReFeRenCeS mAtteR FoR tRAnSFoRming Food SyStemS FoR SuStAinABle HeAltHy dietS IFPRI Issue Brief | June 2024 2 9.9 percent). While the share of the AFS in total GDP declined from 30.8 to 27.5 percent between 2009 and 2019, as a result of even more rapid growth in the rest of the national economy, the share of primary agriculture alone in GDP dropped from 17.8 to 13.2 percent. Thus, in 2019 (and for a few years prior), the off-farm components generated a larger share of value added to the AFS GDP than the agriculture sector did. The share of the agricul- ture sector labor force in the national economy’s total labor force fell from 54.1 percent in 2009 to 45.9 percent in 2019, signifying a larger reduction in agriculture sector employment than in agriculture’s GDP share, suggesting that agricultural labor productivity increased. Supplying the domestic market was the dominant driver of Bangladesh’s AFS growth in the 2009–2019 period (Diao et al. 2023). Value chains of import-substitut- able and less-traded products contributed the lion’s share of the AFS GDP but grew at a lower average rate than export-oriented value chains, and from a much lower base. Import-substitutable value chains that saw fast growth included maize, beef, and dairy products; fast-growing, less-traded value chains included aquaculture products; and wild-caught fish was one of the fast-growing, export-oriented value chains. The dual effect of higher labor productivity, especially in food value chains oriented toward the domestic market, and lower labor force partic- ipation in the agriculture sector also drove an accelerated transition in household consumption from own-produced to purchased foods. Furthermore, annual growth in food production regularly exceeded annual population growth, contributing to improved food availability across the population, and the country’s self-sufficiency in rice production was steady across these years (FPMU 2021). As a result, the prevalence of undernourishment declined nationwide from 15.2 percent in 2010 to 14.3 percent in 2016 and 11.8 percent in 2019 (FAOSTAT 2024), and household diet quality improved overall. Between 2010 and 2016, household diet quality — measured by IFPRI’s Reference Diet Deprivation index (ReDD) (Pauw et al. 2023) — improved throughout Bangladesh, as shown in Figure 1. Diet quality improved fastest in rural areas, but remained lower in these areas than in Bangladesh’s major cities and other urban areas. These dietary improvements, combined with large- scale investments in community health-worker programs and adoption of innovative methods to deliver maternal and child health and nutrition services, led to reductions in child stunting and wasting prevalence at the national level from 41.3 and 15.6 percent in 2011 to 30.8 and 8.4 percent in 2018, respectively (El-Arifeen et al. 2017; NIPORT and ICF 2020). However, child stunting remained more prevalent in rural areas than urban areas, with a rate of 32.8 percent compared with 25.4 percent in 2018. The greater availability of calorie-dense foods, combined with strong consumer demand for these foods (see below) and household income growth, also gave rise to rapid increases in the prevalence of overweight and obesity among adults. The prevalence rate of overweight (includ- ing obesity) among women of reproductive age nearly doubled nationwide, from 16.5 to 32.4 percent between 2011 and 2018, and remained considerably higher in urban areas than rural areas (NIPORT and ICF 2020). Alarmingly, the prevalence of obesity — the more extreme form of caloric overnutrition—more than doubled nation- wide between 2011 and 2018 (from 2.9 to 6.5 percent), and rose faster in rural areas than urban areas (from 1.7 to 4.9 percent and from 6.4 to 10.8 percent, respectively). Associated with the growing overnutrition problem, the risk of noncommunicable diseases such as type 2 diabe- tes and coronary heart disease has also risen (Nguyen et al. 2022; Riaz et al. 2020). FIgURE 1 Change in household diet quality in Bangladesh by residential area 2010 2016 0.55 0.45 0.46 0.47 0.48 0.49 0.50 0.51 0.52 0.53 0.54 D ie t q ua lit y in d ex (1 - R eD D ) City (Δ = 1.2%) Other urban (Δ = 3.2%) Rural (Δ = 4.4%) Source: Authors’ estimates based on Bangladesh Household income and expenditure Survey data. Note: Redd = Reference diet deprivation index (Pauw et al. 2023). City = dhaka, Chittagong, Khulna, and Rajshahi. ConSumeR PReFeRenCeS mAtteR FoR tRAnSFoRming Food SyStemS FoR SuStAinABle HeAltHy dietS IFPRI Issue Brief | June 2024 3 Recognizing the new challenge and urgency of addressing this growing double burden of malnutrition, Bangladesh’s Ministry of Food emphasizes promoting healthy diets as key to achieving the goal of the National Food and Nutrition Security Policy (NFNSP) — that is, to achieving the Sustainable Development Goals targets related to food and nutrition security and fulfilling related national and international commitments by 2030. The first three (of five) objectives of the NFNSP Plan of Action for 2021–2030 focus on the steps for achieving healthy diets (FPMU 2021, 14): 1. Ensure availability of safe and nutritious food for healthy diets. 2. Improve access to safe and nutritious food at an affordable price. 3. Enhance the consumption and utilization of healthy and diversified diets for achieving nutri- tion improvements. To achieve the third objective, and hence NFNSP’s goal, a better understanding of consumer behavior is crucial. Dietary Change in Rural Bangladesh With increasing real incomes per capita, rural house- holds started to shift their diets from being heavily dominated by staple foods toward greater consumption of non-staple foods, as predicted by Bennett’s Law (Bennett 1941). Estimates from IFPRI’s Bangladesh Integrated Household Survey (BIHS) data, which include a large, nationally representative panel sample of rural households, suggest that the share of calories from rice and other starchy staple foods in rural household diets consumed at home declined from 88.0 percent in 2011 to 73.1 percent in 2015 and 71.0 percent in 2018. In contrast, pulses and nuts, added fats and oils, and animal-source food consumption all increased steadily between the survey years, with average calorie consumption amounts up by 44.1 percent, 39.7 percent, and 23.7 percent from 2011, respectively, by 2018. While these changes in the dietary patterns of rural households’ at-home consumption indicate a clear shift toward a more diverse diet better balanced across nutritionally essential food groups, the average rural diet still fell short of the recommended Bangladeshi diet (as defined in 2013 by the National Dietary Guidelines of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders; Nahar et al. 2014). Figure 2 shows that the average rural diet fell even further short of the healthy reference diet defined by the EAT-Lancet Commission on Food, Planet, Health — a global reference diet that meets the nutri- tional requirements of most people and, if consumed by all people, would keep the world within the planetary boundaries for sustainable food production (Willett ConSumeR PReFeRenCeS mAtteR FoR tRAnSFoRming Food SyStemS FoR SuStAinABle HeAltHy dietS IFPRI Issue Brief | June 2024 4 et al. 2019). In all three survey years, the shortfalls of the average rural diet in terms of the reference intakes of both the recommended Bangladeshi diet and the EAT-Lancet reference diet were largest for pulses and nuts, fruits, and animal-source foods, whereas rural households on average still vastly overconsumed starchy staples and also, in 2018, added fats and oils relative to recommended intakes. The total calorie content of the average rural diet was roughly constant and somewhat above the optimal calorie intakes of the Bangladeshi dietary guidelines and the EAT-Lancet reference diet. While the average calories consumed by rural households at home declined slightly between 2011 and 2018 (Figure 2), food consumption away from home increased. The average share of food- away-from-home consumption expenditure in total food expenditure rose from 6.5 percent in 2011 to 8.8 percent in 2015 and jumped to 15.9 percent in 2018.1 Increasing consumption of food away from home is a typical dietary 1 Because quantities of foods purchased and eaten outside the home were not surveyed, calorie consumption away-from-home cannot be calculated. shift characterizing the observed nutrition transition in developing countries; it has been well-documented for urban settings but less so in rural areas (Hawkes et al. 2017; Popkin et al. 2012). Food Preferences of Rural Consumers Estimated income and price elasticities of food demand are important indicators of consumers’ revealed food preferences. They measure the expected percentage change in food consumption in response to a 1 percent change in household income or food prices. Table 1 reports the estimated, long-term income and own-price elasticities for total food demand and the demand for 15 main food groups. These long-term elasticities are estimated using two-stage food demand system models (see Ecker and Comstock 2021) and household panel data from the BIHS in 2011, 2015, and 2018. They are calculated FIgURE 2 Caloric composition of the average diet in rural Bangladesh and reference diets by major food groups Added sugar & others Added fats & oils Animal-source foods Pulses & nuts Fruits Vegetables Stachy staples 2011 2015 2018 BGD EAT 3,000 0 500 1,000 1,500 2,000 2,500 C al o ri e co ns um p tio n p er A E (k ca l/ d ay ) Source: Authors’ estimates based on Bangladesh integrated Household Survey panel data. Note: Ae = adult equivalent. Following the approach described in Headey et al. (2023), the reference adult has a total daily calorie intake of 2,500 kcal per day. Bgd = Bangladesh dietary guidelines (nahar et al. 2014). eAt = healthy reference diet of the eAt-Lancet Commission on Food, Planet, Health (Willett et al. 2019). the food group “added sugar & others” includes all nutritionally nonrequired foods, such as sugar- sweetened beverages and other highly processed food products, in addition to refined sugar and other sweeteners. ConSumeR PReFeRenCeS mAtteR FoR tRAnSFoRming Food SyStemS FoR SuStAinABle HeAltHy dietS IFPRI Issue Brief | June 2024 5 as averages across all households and the three survey rounds. The 15 food groups are a further disaggregation of the major food groups shown in Figure 2, adopted to reflect potentially diverse preferences for foods within those major food groups. The estimated income elasticities of the demand for fruits and all animal-source foods are considerably higher than the estimated income elasticity of total food demand and show values around or notably greater than one. This implies that the consumption of these food groups tends to increase faster than total food consumption when rural household incomes grow, and at percentage rates roughly proportional to the income growth rate in the case of eggs, poultry meat, and wild-caught fish, or even more than proportional growth in income in the case of fruits, farm-raised fish, dairy products, and red meat. These strong consumer pref- erences have been important drivers of dietary change among rural Bangladeshis and, as main pull factors from the domestic market, the rapid development of Bangladesh’s aquaculture and cattle value chains and the associated transformation of the national AFS in recent years. Given still low consumption levels of fruits and animal-source foods, rural households’ desire to increase their consumption of these foods can be expected to be strong with continued economic growth. The income elasticities of the demand for staple foods and added sugars and other foods, which mostly include sugar-sweetened beverages and other highly processed foods, reveal consumer preferences that have driven other observed dietary shifts and associated public health risks in rural Bangladesh. The income elasticities, especially of coarse rice demand and starchy root and tuber demand, are much lower than the income elas- ticity of total food demand, indicating that consumers transition out of unrefined starchy food consumption. On the other hand, the income elasticity of the demand for added sugars and other foods is higher than that of total food demand, pointing toward strong preferences for those nutritionally undesirable foods, whose excess consumption contributes to obesity and noncommunica- ble diseases. Vegetable demand has an estimated income elasticity similar to that of total food demand. Hence, in rural Bangladesh, the consumption of these micronutrient-rich foods is likely to increase only at a rate similar to total food consumption. While the estimated income elasticity for pulse and nut demand is somewhat higher, the large gap observed between current consumption levels and recommended intakes is unlikely to narrow rapidly without targeted efforts, given generally very low consumption. The estimated own-price elasticities, which indicate the likely change in the consumption of a food group in response to a price change of that food group, are consistently larger for individual food groups than for total food demand, in which all food group prices are summarized in a food price index. This is because of substitution effects in household consumption between different food groups in response to relative price changes (these are captured in estimates of cross-price elasticities, not reported here). The reported price TaBlE 1 Estimated income and price elastici- ties of food demand in rural Bangladesh Income elasticities Own-price elasticities Total food 0.79 *** -0.54 *** Fine & medium rice 0.93 -1.51 * Coarse rice 0.45 *** -0.78 *** Other cereals 0.66 * -0.84 Starchy roots & tubers 0.42 *** -0.64 *** Vegetables 0.77 *** -0.87 *** Fruits 1.66 *** -0.18 Pulses & nuts 0.90 *** -1.11 *** Red meat 1.20 *** -0.57 *** Poultry 0.94 ** -0.79 Eggs 0.96 *** -0.64 *** Dairy 1.24 *** -1.02 *** Farm-raised fish 1.37 *** -0.70 *** Wild-caught fish 1.04 *** -0.89 *** Added fats & oils 0.63 *** -0.70 *** Added sugar & others 0.85 *** -0.65 *** Source: Authors’ estimates from two-stage demand system models based on household panel survey data from the Bangladesh integrated Household Survey in 2011, 2015, and 2018. Note: ***, **, * Bootstrapped standard errors indicate that the elasticity estimates are statistically significantly different from zero at the 1%, 5%, and 10% level, respectively. the food group “added sugar & others” includes all nutritionally nonrequired foods, such as sugar- sweetened beverages and other highly processed food products, in addition to refined sugar and other sweeteners. ConSumeR PReFeRenCeS mAtteR FoR tRAnSFoRming Food SyStemS FoR SuStAinABle HeAltHy dietS IFPRI Issue Brief | June 2024 6 elasticity estimates suggest that the demand for fine and medium rice, pulses and nuts, dairy products, wild-caught fish, and vegetables are most sensitive to own-price changes. Agricultural value chain growth that leads to price reductions for these foods thus can be expected to increase their consumption considerably. The estimated own-price elasticities for fine and medium rice, pulses and nuts, and dairy products are also larger than unity, indicating that a 1 percent price decline increases their consumption by more than 1 percent, which requires reducing consumption of other food groups. For example, declining prices for fine and medium rice incentivize rural households to reduce their consumption of coarse rice and other cereals primarily and spend the freed income for additional fine and medium rice consumption. Similarly, declining pulse and nut prices lead to increases in their consumption associ- ated with declines in consumption of fine and medium rice, red meat, and vegetables. Conclusions Diet quality, the prevalence of overweight and obesity, and the risk of diet-related NCDs have all been higher in Bangladesh’s urban areas than rural areas — a common pattern across countries of the global South. Yet, dietary change and the rise of overweight were faster in rural Bangladesh during the pre-COVID decade, high- lighting the urgency for AFS transformation strategies that promote healthy diets and address the growing double burden of malnutrition in rural areas. Strong consumer preferences for animal-source foods and added sugars and highly processed foods combined with continued high demand for staple foods suggest that, with continued income growth, this nutrition tran- sition will further accelerate in rural areas, if no policy action is taken. This brief indicates the main pathways through which policies could influence food systems transformation. First, agricultural policies have a particular role to play in changing relative prices for consumers, which could help to transform Bangladesh’s national AFS and achieve sustainable healthy diets. Such agricultural policies include public investments to catalyze productivity growth within high-value horticultural crops for local markets, as specified in Bangladesh’s 2018 National Agriculture Policy (MOA 2018). Promotion of the development of specific agricultural value chains such as fruits, pulses, and various animal-source foods can be an important policy instrument for improving household diets, though the promotion of other value chains can lead to undesirable dietary change if food consumption incentives conflict with nutritional needs. Second, with continued transformation of Bangladesh’s AFS and income growth, households’ consumption patterns gradually shift away from staple foods (see also, de Brauw et al. 2019). Policies designed to affect relative prices and further catalyze a shift toward more nutrient-dense and healthy foods could be complemented by behavior change programs designed to increase consumers’ desire for those foods. While behavior change programs are effective among the poor receiving cash or food transfers in Bangladesh (Ahmed et al. 2019), their effectiveness in shaping diets among more affluent population groups is less clear and an area for complementary research to this study. Under the CGIAR Initiatives on Foresight and Sustainable Healthy Diets (SHiFT), research following the analysis presented in this brief will assess the effects of growth in various agricultural value chains on household diet quality and environmental sustainability of consumed diets, as well as the potential trade-offs of different AFS transfor- mation paths for achieving sustainable healthy diets in rural Bangladesh. ConSumeR PReFeRenCeS mAtteR FoR tRAnSFoRming Food SyStemS FoR SuStAinABle HeAltHy dietS IFPRI Issue Brief | June 2024 7 INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE A world free of hunger and malnutrition IFPRI is a CGIAR Research Center 1201 Eye St, NW, Washington, DC 20005 USA | T. +1-202-862-5600 | F. +1-202-862-5606 | Email: ifpri@cgiar.org | www.ifpri.org | www.ifpri.info Handle: https://hdl.handle.net/10568/144173 © 2024 International Food Policy Research Institute (IFPRI). This publication is licensed for use under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Olivier Ecker is a senior research fellow, Andrew R. Comstock is a senior research analyst, and Xinshen Diao is a senior research fellow, all in the Foresight and Policy modeling unit, international Food Policy Research institute (iFPRi). Alan de Brauw is a senior research fellow in the markets, trade, and institutions unit, iFPRi. Md. 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