Changing food environments in Asia Pacific region

Food availability has changed markedly in the region, particularly as a result of urbanisation. Asia leads the world in its rapid urbanisation, with over a quarter of the world’s estimated urban population growth by 2050 expected to occur in India and China⁽¹⁹⁾. In terms of nutrition, urban, as opposed to rural food environments, tend to offer greater food diversity. However, this has also been accompanied by rising availability of processed or pre-prepared foods high in fat, salt and sugar^{(19–Reference Liu, Wahl and Seale23)}. A critical upstream driver of availability is trade in food and beverages. Rising international food trade has increased the availability of diverse foods and contributed to improvements in dietary quality and reductions in undernutrition^{(Reference García-Dorado, Cornselsen and Smith24)}. However, this very much depends on the commodity being traded, and limited research indicates that imports of cheap, energy-dense foods and sugar-sweetened beverages are a concern across the region^{(Reference Krivonos and Kuhn25,Reference Baker, Kay and Walls26)} . For instance, India and China are two of the top five markets worldwide for sales of sugary drinks^{(Reference Popkin, Corvalan and Grummer-Strawn27)}.

Food price also has a significant influence on food consumption habits in Asia and the Pacific^{(19,28,Reference Farrell, Thow and Schuster29)} . A major challenge is that the cost of nutritious food, such as fruit and vegetables, is often higher than less healthy foods high in sugar, salt and fat^{(Reference Headey and Alderman30,Reference Dizon and Herforth31)} . Our recent analysis of food trade data across the region indicates that the price of less healthy food (including fatty meat and snack foods) has risen at a slower rate than for healthier foods (including fresh fruit and vegetables, root crops and whole grain cereal)^{(Reference Thow, Farrell and Helble4)}. As a result, the price gap between less healthy foods and healthier foods has widened across the region from 2003 to 2018, with less healthy foods becoming relatively cheaper. Limited availability of affordable nutritious foods is a particular barrier to healthy diets among the urban poor; 69 % of the world’s total urban poor live in Asia^{(Reference Mathur32)}. Extremely poor urban households can spend more than half of their household budgets on food and often have low diet quality^{(Reference Ruel, Garrett and Yosef22,Reference Oli, Vaidya and Thapa33)} . These trends are concerning from a health equity perspective, particularly for poor urban populations who are often more dependent than rural populations on purchased foods⁽¹⁹⁾. History has shown that recent economic crises, notably the 2007–2008 global financial crisis and the 1997–1998 Asian financial crisis, have had significant impacts on food and nutrition security as incomes, food prices and poverty reduction and nutrition programmes were impacted^{(3,Reference Wiggins and Keats34)} . There is little doubt that the economic downturn associated with the COVID-19 pandemic will influence food and nutrition security^{(Reference Farrell, Thow and Wate35)}.

The nature and prevalence of food marketing in the region is relatively poorly documented, despite the fact that it can have a major influence on consumption patterns^{(Reference Boyland and Whalen36)}. Two recent studies suggest that food advertising is dominated by foods associated with the nutrition transition, such as snack foods and sugary beverages^{(Reference Liu, Yu and King37,Reference Chen, Wu and Wen38)} . In addition, marketing targeting children is an evident concern in the region. Studies in Thailand, China, Indonesia, Malaysia and South Korea have found that the most frequently advertised (food) product was sugar-sweetened drinks, and that rates of non-core (less healthy) food advertising were highest during viewing times most popular with children^{(Reference Kelly, Hebden and King39,Reference Jaichuen, Vandevijvere and Kelly40)} . It is also clear that increasingly intentional strategies are being used to market unhealthy foods and beverages to children, including promotional characters, free gifts, health claims and sponsorship of school sport^{(Reference Liu, Yu and King37,Reference Jaichuen, Vandevijvere and Kelly40–Reference Kelly, King and Jamiyan45)} .

Access to healthy food is also heavily influenced by the nature of food retail, which has changed markedly across the region and remains extremely diverse – including supermarkets, open market vendors, informal street vendors and restaurants^{(19,Reference Ruel, Garrett and Yosef22,Reference Liu, Wahl and Seale23)} . Wet markets selling fresh food remain a vital component of food retail and can be associated with increased vegetable consumption^{(Reference Hawkes, Harris and Gillespie20,Reference Kelly, Seubsman and Banwell46)} . However, the urban poor often need to travel long distances, incurring additional expenses, to overcrowded retail markets or street stalls where hygiene, drainage, clean water and waste disposal are often insufficient^{(Reference Seidler47)}. In contrast, consumers with middle or high incomes often shop at modern supermarkets, which tend to be conveniently located and offer a diverse range of foods at lower prices^{(Reference Seidler47)}. The growth of the grocery retail sector, or ‘supermarketization’, is a key driver of ongoing food system change in low- and middle-income countries in the region^{(Reference Reardon, Timmer and Minten48)}. They have both positive and negative implications for access to healthy food: on the one hand, they offer a diverse range of nutritious foods with (often) high food safety standards; on the other, they can increase access to highly processed, less healthy foods^{(Reference Hawkes49,Reference Baker and Friel50)} . There is also evidence to suggest that the retail food environment surrounding schools in the region preference less healthy options, such as soft drinks and fast food outlets^{(Reference Li, Dibley and Yan42,Reference Reeve, Thow and Bell51)} .

With rising use of the internet and mobile technologies in the past ten years, food delivery services using an online application have grown rapidly in Asia, further accelerating during the COVID-19 pandemic^{(Reference Voon52)}. Food delivery services have been one of the solutions to obtain food during the COVID-19 pandemic; however, the nutritional value of these takeaway foods is often low; they are often high in salt and fat and energy dense^{(Reference Ren, Luo and Zhao53)}.

Opportunities for future research

Although countries in the Asia Pacific region have a high level of political will to address the significant burden of malnutrition in all its forms, the implementation of context-specific food environment policies is hampered by limited data on food prices, availability, marketing and retail. Improved research into food environments in the region would support policy makers to better target these policies and also support monitoring of policy implementation and impacts. While there are clear indications that food environment change is contributing to the dietary transition in the region, research to date has been patchy.

Informing strong policies to improve food environments will require further in-depth research at the regional, national and local levels with a particular focus on sub-national trends and contextual differences, as well as on vulnerable populations. Priorities for research include improving understanding of relative food availability – for example by mapping of food retail outlets, particularly in low-income neighbourhoods and surrounding schools, systematic analysis of pricing trends at national and cross-national levels, and monitoring of marketing practices. It will also be beneficial to examine food environments in light of the traditional healthy food cultures in the region. In South Korea and French Polynesia, integrated food policy that intentionally fosters traditional food cultures has supported positive dietary change^{(Reference Engelberger, Johnson, Fanzo, Hunter and Borelli54,Reference Kim, Moon and Popkin55)} .

In conclusion, more granular and context-specific data regarding the food environments in which people make decisions regarding their food purchasing and consumption will be invaluable in informing targeted and well-designed policy interventions in Asia and the Pacific region. It will also be essential for monitoring the effectiveness of policy interventions to improve diets and health.