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The rising cost of a healthy diet Shaping Policy for
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Overseas Development Institute,203 Blackfriars Road. London SE1 8NJ,Tel 44 0 20 7922 0300,Fax 44 0 20 7922 0399. E mail info odi org uk,www odi org,www odi org facebook. www odi org twitter, Readers are encouraged to reproduce material from ODI Reports for their own publications as long as they are not being sold commercially As copyright. holder ODI requests due acknowledgement and a copy of the publication For online use we ask readers to link to the original resource on the ODI website. The views presented in this paper are those of the author s and do not necessarily represent the views of ODI. Overseas Development Institute 2015 This work is licensed under a Creative Commons Attribution NonCommercial Licence CC BY NC 3 0. ISSN 2052 7209,Cover photo Cover photo credit and caption.
In high income countries over the last 30 years it seems that the cost of healthy. Key items in the diet has risen more than that of less healthy options thereby. messages encouraging diets that lead to excess weight. It seems the same may apply in emerging economies such as Brazil China Korea. and Mexico where prices of fruit and vegetables have been rising more than most. other foods including energy dense processed foods. A strong case emerges for using taxes and subsidies to offset these changes to. encourage more consumption of healthy foods and less of unhealthy items. developmentprogress org,Abbreviations Glossary 6,Acknowledgements 6. 1 Introduction 11,2 Research questions and objective 16. 3 What is already known 20,3 1 United States 21,3 2 United Kingdom 29. 3 4 Brazil 34,3 5 China 36,3 6 Republic of Korea 36. 3 7 Mexico 37, 3 8 Summary of literature from emerging economies 38.
4 Data and methods 39,5 Results of analysis price movements 42. 5 1 Brazil 43,5 2 China 44,5 3 Republic of Korea 45. 5 4 Mexico 46,5 5 United Kingdom 47,5 6 Comparative analysis 48. 6 Conclusion and discussion 50,6 1 Changing prices 51. 6 2 Do prices matter and might taxes work 51,References 54.
4 ODI Report, Figure A Estimated average annual price changes from 1990 10. Figure 1A1 Foresight s causal map of overweight and obesity clustered by type of driver 13. Figure 1A2 Extract from Foresight s causal map of overweight and obesity 13. Figure 1 1 Prevalence of adult overweight and obesity in four countries plus the UK and USA 1980 2008 14. Figure 1B1 Average diets six countries 2010 standardised scores 16. Figure 1B2 Changes in consumption of healthy and unhealthy foods six countries 1990 2010 changes to. standardised scores 16, Figure 2A1 Energy density of selected healthy and less healthy snacks USA kcal per 100 grams 19. Figure 3 1 Prevalence of overweight and obesity USA by age and sex 2011 12 22. Figure 3 2 Relationship between cost of per unit of energy and energy density for 372 foods in Seattle area. supermarkets 2006 23, Figure 3 3 Energy density and price per calorie for selected snack foods fruit and vegetables USA 2008 23. Figure 3 4 Price indices for selected foods and beverages in the USA 1980 2010 24. Figure 3 5 Long term average annual changes in retail prices for selected foods in the USA 25. Figure 3 6 Fruit and vegetables and junk food unit values and corrected prices relative to total food 30. Figure 3 7 Contribution of different food groups to daily diet costs of healthiest and least healthy group of eaters adult. women UK 1995 98 31, Figure 3 8 Diet costs per calorie and energy density Scotland 2011 32. Figure 3A1 Kcal changes associated with adjusting meals to healthier options 33. Figure 3A2 Cost of different diets from three types of shop 33. Figure 3 9 Proportion of energy from different food groups urban household purchases Brazil 1996 2009 35. Figure 3 10 Cost per kilocalorie for different food groups in Brazil 36. Figure 3 11 Cooking oil prices China 1991 2006 37, Figure 3 12 Vegetable consumption in Republic of Korea 1969 2009 grams per person per day 38.
Figure 3 14 Consumption of soft drinks per person per day USA UK Mexico Brazil Korea and China 2008 38. Figure 3 13 Annual sales of selected ultra processed foods and drinks 12 Latin American countries 1999 2013 38. Figure 5 1 Price of selected foods S o Paulo Brazil 1980 2009 44. The rising cost of a healthy diet Changing relative prices of foods in high income and emerging economies 5. Figure 5 2 Price of selected foods China urban areas 1989 2006 45. Figure 5 3 Prices of selected foods Republic of Korea 1975 2013 46. Figure 5 4 Prices of selected foods Mexico 1980 2014 47. Figure 5 5 Prices of selected foods United Kingdom 1974 2012 48. Figure 5 6 Estimated average annual price change from 1990 50. Table 2 1 Causal chain from costs of food to consumption obesity and ill health 18. Table 3 1 US own price elasticity of demand by food and beverage category 1938 2007 26. Table 3 2 Own price elasticity of demand for four food groups in the USA 2007 12 26. Table 3 3 Estimates of food price elasticity in the UK long run 32. Table 4 1 Food prices analysed for each food group and country 41. Table 4 2 Data sources and deflators used for country cases 41. Table 5 1 Results of log linear regression of time on prices 49. Box 1A Mapping drivers of overweight and obesity spaghetti junctions ahead 13. Box 1B Changing diets in the four countries UK and USA 16. Box 2A Energy density of foods 19, Box 3A Cheap eats and healthy treats affordable for families of obese children in the UK 33. Box 3B Marketing of processed food in Brazil 35,Box 6A How feasible are taxes on foods 54. 6 ODI Report,Abbreviations Glossary,BLS US Bureau of Labour Statistics. BMI Body Mass Index body mass compared to square of height kg m2 BMI of 25 or more indicates overweight 30 or. more indicates obese,CPI Consumer Price Index, Eatwell Plate UK government guide to the composition of a healthy diet. Energy density A measure of calories per unit of food. FAFH Food away from home food consumed outside people s homes as in restaurants etc. FAO Food and Agriculture Organizsation of the United Nations. GDP Gross Domestic Product,HIC High Income Country.
LIC Low Income Country,MIC Middle Income Country, Nutrient density A measure of how many healthy nutrients are in a food usually by weight. Potato chips US term the same as UK potato crisps, Prices constant or real Nominal prices from which inflation in general price levels have been removed either by use of a consumer price. index or GDP deflator, Prices indices Prices expressed as ratio of those at a base year when values are usually set to 100 Indices may or may not be. adjusted for inflation The price indices constructed in this paper have been adjusted for inflation. Prices nominal Prices as observed at a given time with no adjustment for inflation. SNAP Supplemental Nutrition Assistance Program USA. SSB Sugar sweetened beverage or soda in US English. UMIC Upper Middle Income Country,USDA United States Department of Agriculture. WCRF World Cancer Research Fund,Acknowledgements, Many thanks to the following for their contribution to this report.
For China the report uses data from the China Health and Nutrition Survey CHNS so we thank the National. Institute of Nutrition and Food Safety China Center for Disease Control and Prevention Carolina Population Center. 5 R24 HD050924 the University of North Carolina at Chapel Hill the NIH R01 HD30880 DK056350 R24. HD050924 and R01 HD38700 and the Fogarty International Center NIH for financial support for the CHNS data. collection and analysis files from 1989 to 2011 and future surveys and the China Japan Friendship Hospital Ministry. of Health for support for CHNS 2009, For Korea Heejo Ku and Jae eun Myung provided excellent research assistance. For Mexico Dra Alejandra Donaj Ben tez Arciniega UAEMex Medicine Faculty provided valuable support. Fumiaki Imamura Cambridge and colleagues kindly supplied data on changing diets in the four countries. Corinna Hawkes WCRF peer reviewed the report and her detailed and incisive comments on an earlier version. helped to sharpen the thinking and,Deborah Eade copy edited the report. This report forms part of the ODI project Shockwatch managing risk and building resilience in an uncertain world. which is supported by the UK Department for International Development DFID. The interpretations and opinions expressed in the report are not necessarily those of the above mentioned persons nor. of the Overseas Development Institute The main authors are solely responsible for any errors and omissions. The rising cost of a healthy diet Changing relative prices of foods in high income and emerging economies 7. Motivations and questions less is known about the evolution of national retail prices. In 2014 our previous study Future Diets Keats and of food in the form presented to consumers Hence the. Wiggins 2014 described how across the world an central questions posed in this report. increasing share of the population is overweight and. obese with the rate of increase particularly pronounced What changes have been seen in the retail cost of food. in developing countries No nation however has stemmed in the four countries since 1990 Are there systematic. the rising rates of people who are overweight and obese differences in the evolution of prices for different foods. Effective policies to combat obesity have yet to be proved and hence changes in relative prices. if only because no country has yet tested a sufficiently In particular has processed food become cheaper relative. comprehensive set of policies The causes of excess weight to unprocessed staples fruit and vegetables meat and. are multiple including rising incomes urbanisation and dairy produce This may be expected since much of the. more sedentary occupations the influence of media and retail cost of processed food arises in manufacturing and. advertising and changing relative prices of different foods logistics where technical advances have reduced unit. This last element is the focus of this report costs perhaps by more than advances in farming have. The report starts from two working hypotheses reduced the cost of agricultural produce. a When the relative prices of foods change people will It was possible to examine only a sample of the many. consume more of foods that have become relatively less foods on offer in retail outlets the aim being to have at. expensive and less of those that have become relatively least one example from the following food groups. more expensive People on low incomes are expected, to be more sensitive to prices than those on higher Staples Cereals root crops legumes. incomes and Fruit and vegetables Fruit and vegetables. b When consumption of foods with high calorie content Meat fish and dairy Minimally processed animal. per unit weight energy dense foods increases at the products and milk products. expense of food that is less dense in energy we may Oils fats and sugar Vegetable oils and fats. expect to see a significant increase in the prevalence of animal fats sugar. overweight and obese people Highly processed foods Foods usually produced. by industrial processes, If these hypotheses are correct they would suggest that. using taxes and subsidies to influence diets is likely to be. effective What is already known Insights from the, To the best of our knowledge there is no existing study literature.
that compares the changing costs of foods from separate Published studies for the UK and the USA frequently report. food groups across a sample of developing and emerging the following even if contrary findings and qualifications. economies The report focuses on four countries three can be found in many other studies. upper middle income countries UMICs Brazil China, and Mexico and one high income country HIC the Most studies find that healthier foods cost more than. Republic of Korea which was still a developing country in less healthy ones Moreover this effect has increased. 1990 They have been chosen since they represent emerging over the last 30 40 years as energy dense processed. economies that are growing faster than most industrialised foods have become cheaper relative to less energy dense. countries and where since 1990 significant changes may fruit and vegetables. be expected in both diets and the relative prices of foods Consequently healthy diets tend to cost more than less. Analysis of prices in the United Kingdom UK has been healthy diets This is not inevitably so choosing cheaper. added to provide some comparison The literature from healthy items and substituting them for costlier less. the United States USA has been reviewed given the healthy ones might both improve diet and save money. large number of studies that report on the price of food But for most consumers this would require both the. the effect on food consumption and in some cases the ability to see the distinctions and the discipline to. consequences for body weight follow a particular diet. While changes in prices of some foods such as bananas Although it seems that some energy dense processed. beverages cereals dairy produce edible oils and sugar on foods have become notably cheaper compared to fruit. international and national markets are regularly reported and vegetables the nature of the latter have changed. 8 ODI Report, with higher value prepared items common in food City In the UK household surveys reported both spending. outlets and also available all year round Taking such and quantity for 330 foods Hence it was possible to create. added value into account the change in relative prices unit prices paid by dividing expenditure by the quantity. may be less than is at first apparent Price series have been deflated by either the consumer. Consumption of most foods responds to price changes price index CPI or the Gross Domestic Product GDP. although for many foods the response is relatively deflator to remove the effect of inflation and allow. inelastic but far from perfectly so Those on low comparison over time Once prices were deflated indices. incomes are most likely to respond to changing prices of theses deflated prices were constructed to see how much. Studies of the impacts of food taxes that often seem prices of different foods in each country had changed since. to trigger tiny changes in consumption obscure these the same base year. findings but this is because most studies observe or model More formal testing of price changes was carried out by. the effects of very low taxes 5 or less being typical regressing time on deflated and logged prices from 1990. Cross price effects matter in assessing the nutritional to a recent year in most cases 2012 This allowed a test of. effects of price changes Taxes on fat or salt content whether a significant log linear trend can be inferred and. may affect consumption of other complementary foods if so what the average annual price change has been. leading to less consumption of beneficial nutrients. Using tax revenues to subsidise such complementary. foods would counter this effect Results, Studies of the impacts of changes in prices on body The key findings from the analysis come from estimated. weight produce a surprisingly strong consensus annual price changes see Figure A. that higher prices of unhealthy options reduce body Two things are readily apparent One is that prices of. mass index BMI as do cheaper healthier options fruit and vegetables have risen substantially since 1990. Surprising since body weight is the outcome of many mainly by between 2 and 3 a year on average or. factors yet prices changes can be seen to make a by 55 91 between 1990 and 2012 The other is that. difference The strongest effects are seen among those on four of the six processed products for which estimates are. low incomes who are most sensitive to the cost of food significant show price falls since 1990 Most of the other. foods have seen their prices rise by 1 2 a year with the. There are fewer studies on the four emerging economies exception of the price falls for rice in Korea and chicken in. but they indicate the following Mexico, Some studies link changes in diets above all those. involving more consumption of processed foods to Discussion. processed food and cooking oil becoming cheaper than If the detected trends are real they prompt questions about. other foods the reasons for them If for example technical progress. In Latin America the rising consumption of ultra in farming were uniform so that unit costs of production. processed foods and sugar sweetened beverages SSBs were falling for all agricultural output and if advances. is notable Some see this as the consequence of heavy in the logistics of food wholesaling and retailing were. marketing by the large corporations that manufacture similarly uniform then we might expect the costs of most. much of this food and drink foods to move roughly in line with one another But that is. The possibility of using taxes to reduce consumption of not the case. processed food and SSBs is actively being studied with So why have fruit and vegetables become more costly. most authors seeing the potential to significantly reduce compared to other items It is not as though there have not. consumption Mexico has already introduced taxes on been technical advances in horticulture on the contrary. both SSBs and energy dense food These which came some of the most sophisticated seeds soil nutrition water. into effect in January 2014 will be the focus of intense control and prevention of pests and diseases are seen. scrutiny to see what effects they have precisely in the gardens and glasshouses in which so many. fruit and vegetables are grown While there is a world. of difference between Dutch heated glasshouses and the. Data and methods tiny plots of green beans of central Kenya in both cases. Key data for this report are series for food prices from compared to other agriculture in their neighbourhoods. 1990 to recent years in the four countries plus the UK these systems are both more intensive and use more. Retail prices were sought for representative foods those sophisticated technology than most other local farm. frequently consumed from the food groups listed above enterprises Moreover advances in transport mean that. In most cases directly observed retail prices were used fruit and vegetables are traded more than in the past so. For Mexico however a food price index was used and that retail managers should be able to source from low. calibrated to price levels from observed prices in Mexico cost suppliers no matter where they may be. The rising cost of a healthy diet Changing relative prices of foods in high income and emerging economies 9. Figure A Estimated average annual price changes from 1990. 4 3 2 1 0 1 2 3 4, UK MX MX BR KR CH UK MX MX KR BR BR CH UK MX BR KR CH MX BR KR MX BR KR CH.
Dried rice,Rice Staples,Tortilla and maize flour,Vegetable oil. Soy oil Oil and sugar,Meat Poultry and its products. Beef Meat poultry fish,Vegetables,vegetables,Fresh vegetables. Fresh green vegetables,Cake biscuit and bread,Sweet biscuit. Processed foods,Chocolate and snacks,Ready meals,Ice cream tub block.
Source Table 5 1, Hypotheses can be imagined horticulture may well have on low incomes Hence it is no surprise to see much study. a stepped supply function so that while small quantities of of the potential of taxes on less healthy options to reduce. fruit and vegetables can be supplied at low unit cost once their consumption perhaps even with subsidies on more. a particular volume is reached costs rapidly escalate to a healthy options to raise theirs Most such studies indicate. significantly higher level It may also be that the changes in that imposing taxes would reduce consumption But two. quality noted explain the increased relative prices Or it may qualifications apply. not be a matter of cost but of increased demand from those One is that there may be cross price effects whereby. consumers who appreciate the health benefits of fruit and when taxes raise the cost of a particular food not only does. vegetables These hypotheses merit a separate study its consumption fall but so too does that of complements. Why does not the same apply to some processed foods foods which are typically consumed together such as. One possibility is that much processed food does not rely bread and butter When those complements contain valued. on costly farm ingredients but rather is manufactured nutrients it is thus possible for taxes to reduce the quality. from relatively cheap ingredients the added value being of diet In theory this problem can readily be tackled by. largely in factory processes of combining the ingredients placing a subsidy on the valued complement to offset the. and enhancing their flavour Advances in manufacturing cross price effect In practice learning which foods really. and flavouring probably help reduce unit costs in are complements to what extent and then determining. factory That said processed foods are not uniform in an optimal level of subsidy could lead to a thicket of. quality and pricing since for any sub category there are regulations that have to be adjusted in the light of emerging. usually products that are branded sold on their special evidence creating high administrative costs and giving the. characteristics usually with a price premium as applies impression that such fiscal measures are just too difficult to. for example to SSBs which compete with cheaper contemplate The question is how strong cross price effects. unbranded options This may explain why not all the are and whether they may be remedied by other measures to. processed foods considered show declining constant prices encourage healthier diets. Again additional studies might shed light on this The other is the apparently seductive argument. Evidence presented in the literature review suggests that small taxes would create only small effects that. that prices do affect consumption especially for people considerable change in consumption would require high. 10 ODI Report, taxes that would look disproportionate and unfair say small gains is tantamount to arguments that condemn. more than the rate of value added tax VAT of 20 in doing good because perfection is unattainable. the UK But a logical flaw applies The policy question is In terms of what might be taxed and subsidised. not so much how large a tax would be necessary to bring this report suggests that energy dense foods might be. down consumption of less healthy food X to recommended taxed while fruit and vegetables whose prices often rise. or insignificant levels but how much benefit would be compared to other foods might be subsidised. derived from imposing a politically acceptable tax on Much comes down to the political appetite to. less healthy food X The answer to the former may be contemplate taxing foods Events in Mexico suggest that. a number so high as to be dismissed from the debate some emerging economies may steal a march on HICs in. but the answer to the latter may be as striking as that this respect The evidence presented in this report suggests. provided by Nnoaham et al 2009 for the UK that taxes that the Mexican taxes should achieve considerable good. and subsidies of less than 20 could save no fewer than thereby providing valuable lessons for other developing. 6 400 premature deaths a year from coronary heart disease and emerging economies. CHD and cancers The argument about small taxes, The rising cost of a healthy diet Changing relative prices of foods in high income and emerging economies 11. 1 Introduction, Box 1A Mapping drivers of overweight and obesity spaghetti junctions ahead. A multitude of factors influence an individual s chance of being overweight or obese The UK Foresight study on. obesity identified broad thematic clusters of Social and Individual Psychology Food Production and Consumption. Physiology Individual Physical Activity and Physical Activity Environment outlined in thick dotted lines on their. diagram of interactions Figure 1A1, Figure 1A1 Foresight s causal map of overweight and obesity clustered by type of driver.
Source Map 5 in Butland et al 2007, Within each of the clusters multiple factors interact Below is the food consumption cluster where many of the. economic factors come into see Figure 1A2, Figure 1A2 Extract from Foresight s causal map of overweight and obesity. Source Section of Map in Butland et al 2007, The rising cost of a healthy diet Changing relative prices of foods in high income and emerging economies 13. The prevalence of people who are overweight and obese energy and often unprocessed The answer has implications. is increasing across the world especially so in developing for policy namely the effectiveness of using taxes and. countries Keats and Wiggins 2014 Ng et al 2014 Popkin subsidies to influence diets and hence public health. and Slining 2013 Stevens et al 2012 Some emerging To the best of our knowledge no existing study compares. economies now have almost the same prevalence of the changing costs of foods for separate food groups across. overweight and obesity as seen in high income countries a sample of developing and emerging economies Although. HICs The costs are high Not only does excess weight a simple exercise it could therefore be of considerable. make people more susceptible to heart disease some interest to others studying causes and potential policy. cancers strokes and type 2 diabetes but also it leads to responses to rising levels of obesity. economic losses and higher costs of health care Gortmaker This report aims to understand better how relative. et al 2011 prices of different foods have changed since at least 1990. No nation has stemmed the rising rates of people who are or earlier when data permit and how this may have led. overweight and obese Effective policies to combat obesity to dietary changes Plenty has been documented about. have yet to be proved if only because no country has yet changing relative prices of foods for HICs as will be seen. tested a sufficiently comprehensive set of policies Causes in the literature review of studies of food prices in the. of excess weight are widely agreed to be multiple ranging USA and the UK Less however is known about changes. from the simple economics of rising income and falling in prices in developing countries above all in emerging. costs of many energy dense processed foods which allows economies where the prevalence of overweight and obese. people to eat more to more sedentary lives associated with people is growing fastest This report aims to help fill this. urbanisation to socio cultural effects of advertising and knowledge gap It focuses on four countries three upper. media images and even to potential addiction to highly middle income countries UMICs Brazil China and. palatable foods Hawkes 2008 Kearney 2010 Swinburn Mexico and one HIC the Republic of Korea which was. et al 2011 Often the problem is seen as arising from still a developing country in 1990 They have been chosen. systemic change A systems map of the drivers of overweight since they represent emerging economies1 that are growing. and obesity developed in the UK government s Foresight faster than most of the industrialised countries where since. programme Butland et al 2007 see Box 1A shows just 1990 significant changes may be expected in both diets and. how complex and interrelated the drivers are believed to be the relative prices of foods An analysis of prices in the UK. This report addresses one part of the system the way in has been added to provide some comparison. which prices of food influences choice of diet If diets have Each of these four countries has seen a rapid increase. tended to include more energy dense foods and especially in the burden of overweight and obesity since the 1980s. processed food is this largely because these foods have see Figure 1 1 Although prevalence is still relatively. become relatively cheap compared to food less dense in low in the Asian examples it has grown markedly from. Figure 1 1 Prevalence of adult overweight and obesity in four countries plus the UK and USA 1980 2008. 70 64 1400,Millions of adults overweight obese,Percent of adult population. 40 36 34 800,30 25 25 23 600,20 14 13 400,10 241 200.
US UK Mexico Brazil South Korea China GLOBAL, 1980 2008 Number overweight and obese in 2008 M R axis. Source Compiled from data in Stevens et al 2012, Notes China Latest estimates for overweight and obesity in adults 20 60 years over 35 for men and over 30 for women in 2011 see Figures 12 and. 13 in Annex III 4 Rapid increases in excess weight for those under age 20 from 2008 to 2013 for girls from 4 5 to 13 for boys from 7 to 23 He. 2013 Mexico between 2002 and 2012 much of the increase in people overweight and obese came from already overweight people becoming heavier. 1 By 2015 the Republic of Korea is not usually regarded as an emerging market but was seen as such at the start of the study period in 1990. 14 ODI Report, the 1980s Of the selected countries China has seen The four countries have also seen significant changes. the smallest proportional increase in overweight and in their diets for at least the last 20 years for similar. obesity though the sheer size of China s population reasons to those seen in HICs rising incomes. means the burden of overweight and obese adults though urbanisation more sedentary occupations changes in. representing only 25 of the population outstrips by costs of food and the influence of marketing and media. some 50 million the burden in the UK and USA on tastes Box 1B reports on how while diets across. The medical costs of excess weight are already the world have come to contain more healthy foods in. considerable and rising the four emerging economies they have also tended to. include more unhealthy ones, Brazil annual cost of disease related to excess weight The rest of the report is set out as follows Section 2. is estimated at US 2 1 billion of which US 21 million states the research questions and objectives and presents. is directly attributable to overweight and obesity the hypothesised causal chain from food prices to obesity. Bahia et al 2012 Section 3 reviews the literature on food prices and their. China direct medical costs of adult chronic diseases relation to consumption This begins with the quite large. attributable to overweight and obesity were estimated US literature reviewed because more is known about the. at around Yuan 21 billion in 2003 US 2 74 billion obesity in the USA than anywhere else Following that. Zhao et al 2008 Economic losses from premature some of the literature for the UK and the four emerging. deaths from heart disease strokes and diabetes were economies is reviewed Section 4 records the sources. estimated in 2005 at US 18 billion WHO Factsheet of data and the methods used to analyse it Section 5. at http www who int chp chronic disease report presents the findings Finally Section 6 concludes and. media china pdf ua 1 discusses the results, Mexico Diabetes has been a leading cause of death in More detailed information for the emerging economies.
Mexico since 2002 followed by cardiovascular disease can be found in Appendix III. CVD and brain disease Prevalence of type 2 diabetes. in adults is up from 6 in 2000 to over 9 in 2012,Vald s Ramos 2012. The rising cost of a healthy diet Changing relative prices of foods in high income and emerging economies 15.


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