Capturing the cost of healthy diets

One of the key barriers to better eating is the cost of healthy diets.
| Photo Credit: Getty Images/iStockphoto

Despite falling poverty rates and rising incomes over the last decade or more, India has struggled to substantially improve its nutritional outcomes. The National Family Health Surveys (NFHS) in 2015-16 and 2019-21 show stubbornly high rates of undernutrition among children and high (and rising) rates of anaemia among adults, even as obesity and overweight prevalence has increased in both rural and urban areas.

Healthy nutritious diets are widely recognised as key to tackling the so-called ‘triple burden of malnutrition’, that is, the coexistence of undernutrition, overnutrition, and micronutrient deficiencies, as is the case in India. Unfortunately, most Indians do not consume healthy diets.

One of the key barriers to better eating is the cost of healthy diets. Indeed, rising food prices have been in the news over the last several months, especially for nutritious foods such as vegetables, fruits, pulses, and eggs. Coming as real wages are stagnating, or even declining, this suggests that healthy diets are becoming more and more expensive. The State of Food Security and Nutrition in the World 2024 report estimates that 55.6% of India’s population (788 million people) could not afford to purchase a diet that met their nutritional needs as of 2022.

The problem with Thalinomics

The cost of a thali has recently become a popular way of measuring the cost of meals, especially for the poor. In 2019-20, the Economic Survey devoted a chapter to ‘Thalinomics’, where they calculated the cost of “typical” thalis, i.e., those containing rice and wheat, a mix of pulses (vegetarian thali) or an animal-source protein (non-vegetarian thali), a mix of vegetables, mustard, coconut or groundnut oil, and spices and condiments. The quantities of the food included followed the 2011 Food-Based Dietary Guidelines (FBDGs) developed by the Indian Council of Medical Research-National Institute of Nutrition (ICMR-NIN).

However, the thali does not adequately reflect nutritional recommendations. Its main components account for approximately 61% of the recommended daily requirement of various foods in grams and 65% of the NIN’s 2021 caloric recommendations and exclude several nutrient-rich food groups, notably, green leafy vegetables, dairy, and nuts and seeds. The thali is also data-intensive: it uses quantities from a now dated 2011-12 survey of consumer expenditure by the National Sample Survey (the NSS-CES) to construct weights. While Thalinomics appears to have the advantage of representing “typical” meals, that distinction is artificial if not arbitrary, given the diversity in tastes and variation in the local availability of foods.

An alternate method

Instead, we make a case for the Indian government to track the cost of a healthy diet, or the CoHD, to serve as a routine measure of the cost of meeting nutritional requirements. The CoHD captures the minimum per person per day expenditure needed to meet the daily food group-wise energy recommendations prescribed by national FBDGs, assuming the entire diet is purchased from the market. Our case rests on three facts: one, that the CoHD calculation uses price data that is already available and does not rely on expensive household consumption surveys, as the cost of a thali does. Two, the computations are not complex and can be easily automated and understood. Three, perhaps most importantly, the cost of a thali does not capture the same thing as the CoHD.

To illustrate the last point, we assemble food prices for 328 urban centres and 68 commodities from administrative sources from January 2018 to March 2023. We combine these with the India Food Composition Tables to estimate the quantity of each commodity that would need to be consumed to meet the FBDGs. The costs of the cheapest items in each food group are added to arrive at the least cost of purchasing the recommended diet; the population weighted average across centres gives the national average CoHD.

We use the same price data to compute the cost of a thali. We follow the methodology in Thalinomics, with two deviations: first, we use the 2021 FBDGs as published by ICMR-NIN, same as for the CoHD calculations; second, to keep comparisons simple and do not account for cost of meal preparation.

When we analyse the CoHD and the costs of vegetarian and non-vegetarian thalis, the costs of the two thalis move closely over the period of our data, with the vegetarian thali being about ₹10 cheaper than the non-vegetarian thali, on average. However, the CoHD does not move closely with the thali costs. Both before and after the COVID-19 national lockdown, the CoHD usually lay in between the vegetarian and non-vegetarian thalis, but around the time of the crisis, the CoHD was substantially higher than both. Supply-side disruptions during the COVID-19 lockdowns raised the prices of perishables, which feature in the CoHD.

Our point is simple: these thalis, while intuitive, do not capture the true cost of nutritious diets and can even underestimate them, especially in times of crises. We show that alternate measures are possible, and indeed desirable, since they fully account for nutrition recommendations, do not rely on household consumption data that is expensive and time-consuming to collect, and can account more accurately for short-term fluctuations in the costs of perishable nutritious foods.

Kalyani Raghunathan is with the International Food Policy Research Institute, New Delhi; Sudha Narayanan is with the International Food Policy Research Institute, New Delhi; Anita Christopher is with the International Food Policy Research Institute, New Delhi. Views are personal