Shireen: In this episode, Dr. William Masters discusses the economics of nutrition and food prices. He debunks the misconception that healthy eating must be expensive and offers an explanation of what factors often compete with food for a healthy diet. Tune in to learn about the relationship between food prices and healthy eating in the United States and globally, and what can be done to improve food affordability for all.

Podcasting from Dallas, Texas. I am Shireen. And this is the Yumlish Podcast.

Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Dr. William Masters is an economist at Tufts University in the Friedman School of Nutrition, Science, and Policy. He studies the development of agriculture, food production, and food choice around the world.

 Welcome Dr. Masters.

William: Thanks Shireen. It's really nice to be here and with your whole community.

Shireen: Oh, lovely. A pleasure to have you on. Dr. Masters, why did you decide to pursue a career in economics and policy, particularly for food systems?

William: Yeah, it was a gradual thing for me. Um, as a kid I'd love to travel. Um, I grew up going back and forth between the U.S. and France. So I knew that sort of cultures differed a lot and food differed a lot.

Uh, and I took a semester off and went to Haiti to try to sort of learn about, what life in low-income countries were like, and then a semester off and went to Columbia in South America. Um, and the more I traveled, the more I saw, the more I realized kind of food was pretty fundamental. And that, uh, just for my own personal style, economics was a good way of thinking about it.

So I experimented with trying to be an agronomist and I wasn't very good at biology, uh, but I was pretty good at economics.

Shireen: That's very interesting. So that was pretty much, you know, switching because you weren't good at something.

William: Yes and a few bad final exams will teach you what you're, what you're better at.

Shireen: Yep. Yep. Agreed. Agreed. Um, and so, so let's dive a little bit more into this. How can we use the economics of nutrition to improve healthy eating?

William: Yeah. So the first answer is that economics is really about government policy.

Our audience is really governments and trying to understand what are the effects of these policy instruments that governments do or don't do and trace their effects on people's food choices on companies, food company, you know, how does marketing and advertising and food formulation change and then agriculture.

And, you know, our first audience is squarely governments, but there are interesting lessons. When you think about these things from a systemic point of view, I think some interesting lessons come out of that.

Shireen: Interesting. And can you share what some of those lessons are?

William: Yeah. So most recently I've just been absolutely absorbed in this question of food prices around the world.

So we've had a series of projects trying to add up the costs of foods in terms of their nutritional content, to ask whether agricultural production in different countries and food distribution, and retailing services. When you look at the composition of the items on the shelf and you choose just enough of each item to meet nutrient requirements and also, dietary guidelines like My Plate and so forth. And if you're looking for the least cost items, if you're asking, if the system is delivering at low cost, these nutrients and food attributes in the proportion of need for health, how does that vary around the world? So what we found is really quite surprising things about, uh, diet costs that come from looking at thousands and thousands of item prices.

In, um, about 175 countries around the world and a few countries looking at seasonality and spatial differences within the countries and thinking about, you know, all roughly two dozen vitamins minerals, nutrients, um, and then also food group requirements, and just seeing how these patterns differ. And it's really surprising.

Shireen: Interesting. And so can you share with us some of that research, uh, what are some common misconceptions people have around the cost of a healthy diet?

William: Yeah, so the, the big surprise when we look at the least cost items. So remember the idea here is, does production distribution deliver at low cost? Is that if we know you can have fancy items, like that's obvious, you can have very fancy, healthy foods.

The question is you inexpensive healthy foods. Like, are they available at all? And if they are available, how much do they cost if you went to the market and just sought to buy, you know, the least cost, but healthy items, what is the cost of health? If you strip away all of the various other attributes you might want, um, what would be the cost just to have a healthy diet?

So that's, that's our research question. It's a new kind of question. Um, and the surprising answer is that it's very expensive in low income countries. There's no way in which. Uh, low-income countries have access to these healthier foods at some kind of discounted price, just because they're a low income country.

They still have to pay the full cost of producing fruits and vegetables of producing animal sourced, foods, milk, eggs, and that production cost, especially because nutritious foods are often perishable adds a lot of distribution costs and it's simply out of reach. So our calculated result, the headline number from this line of work is 3 billion people around the world who cannot afford this internationally agreed definition of a healthy diet.

Their incomes are simply too low. So 3 billion people is about 38% of the entire world. And those people having, for those people, having an unhealthy diet is not a matter of choice. Because their incomes are too low for them to be able to even afford it because there's not, these items are simply expensive to make.

And that was our first discovery. And it's really quite surprising to many people, because I think our intuition was that in low-income countries, these items are inexpensive because things are generally in some sense, cheap and low income countries, but that isn't actually true when you do the math. Um, And you add up the number of people who live in those countries and are actually unable to afford it.

So that's our astonishing discovery is that for this roughly 38% of the world, about 3 billion people eating what we would call an unhealthy diet that doesn't allow them to achieve their full growth potential in terms of even just height, but then also child development and cardiovascular health and so forth.

Um, so that the world really needs to, if we want, if we're serious about healthy diets, um, we need to think carefully about safety nets and about income growth for the poorest and ensuring that the programs we take for granted in the U S like SNAP and WIC, that type of program is actually available throughout the world.

Shireen: I do want to, I do want to sort of step back for a second here. Um, so, so as I understand your current research with food prices for nutrition at Tufts focuses really on monitoring food prices across the various countries in order to really guide agricultural production and food markets, um, for improved nutrition.

Um, speaking of the United States, can you discuss more about your work here, specifically what you have learned about food prices and then the affordability and accessibility of healthy eating here?

William: Yeah. So this work does have the motivation that you described. The funding is squarely about low-income countries, but our work has clear implications for high-income countries, too.

And for people in the United States, particularly. The first thing I'd mentioned is that, you know, to the extent that your community is a community, dealing with diabetes, a huge, huge challenge. I imagine every day, I've been very fortunate in health. I can't imagine the sort of magnitude of thought process you have to go through to deal with that.

And a great accomplishment to those who do so successfully. What we find in terms of the cost of nutrients for a median healthy person, so these are nutrient requirements for a median healthy person. This is not any individual who would need to follow, obviously the advice of a dietician, you know, through your programs and others that would provide the tailored guidance.

So when you do this work, as we do systemically to guide U.S. department of agriculture policy for on average, a sort of representative person. What we find is that within traveling distance of just about everyone in the United States, or just about everyone in the United States, if you are eligible for SNAP or WIC, and you receive the full benefit for what you would be eligible, which is not true for everyone, because variety of reasons, people don't always get the benefits for which they are eligible.

Uh, but for essentially everyone who would be eligible for SNAP or WIC or have their own income, a healthy diet is affordable in terms of the ingredients, it is possible to acquire those ingredients. Now, clearly that's just the ingredients and the ingredients for a meal, the ingredients for a days meals, the ingredient for a week or a month's meals takes a lot of planning and cooking and preparation time, and attention to details like spoilage and, uh, and, and variety during the course of the week and making, if you're dealing with children, you know, anybody who has to shop on public transport knows how difficult that is. Anybody who has to shop when, uh, trying to meet the needs of different household members.

Uh, you know, that adds enormous difficulty. So our finding that these items are there. They're just  and affordable in the sense that one could acquire them, uh, really puts a focus on the non-monetary costs here. It really shows how the difficulty of simply acquiring the groceries is only the first step. And those other steps that involve meal planning, food acquisition and planning for the whole week, the whole month, you know, with enough variety and attention to spoilage. And so that you have, you know, you use the things that are gonna spoil first and then the later things so that over the course of the week, um, you know, and then things that, uh, can meet the varied needs of different family members within the time available.

Those are the things that make it really hard. And then the next thing we've discovered is that even when that step of acquiring the least cost items, meal, planning, and so forth, even if that were possible, the overwhelming force of food formulation and marketing, that's selling us other things gives us these aspirations. These very understandable temptations. If you will. People are not just seeking health. People are also seeking self-esteem, fun. People are also seeking lots of cultural goals. If you wanted to have, um, diets that are at odds with your family, your friends, it's really a challenge, you know, and I think there are many leaders in society today who are kind of addressing this head on. Right? So I think of Eric Adams, newly elected mayor of New York who, you know, launches a campaign and like many political figures, he writes a book, you know, at the time of his campaign and publishes a book about his, the things he cares most about, so the voters, all know what he cares about, you know, what does he writes, writes a cookbook.

You know, he writes a cookbook about overcoming diabetes. Like literally that's exactly what it's about. And so I think there's. All of these things come together. And the cost of the groceries themselves is certainly an important factor, but our work is really shining a light on those other constraints, the availability of all the other stuff that is so widely marketed and always at your fingertips and heavily advertised so that all aspirations are guided towards the other things.

Nobody advertises whole wheat toast, and baked beans and a fried egg, nobody advertises mixed vegetables, you know, and whole wheat pasta, nobody advertises, uh, you know, a peanut butter sandwich. That's not an aspirational goal for anyone. And yet that is available everywhere in the United States at affordable costs.

It's just very, very hard to actually plan meals that are satisfactory. You know, under peoples, under people's real real experience.

Shireen: I do want to touch on in, in, um, sort of, uh, dive a little bit deeper into all of those influences that we have. Um, uh, before we move on, though, I want to understand what happens when families traditionally cannot afford the cost of nutritional items, uh, advocacy.

William: Well, people eat inadequate meals. They often skip meals, go to bed hungry. And the meals that they do have are primarily a starchy staple with a little bit of beans or vegetable sometimes, you know, a little bit of egg or cheese or milk, but the primary, you know, as you go down the income ladder, there's a very, very old observation, of Bennett's Law. And, uh, Bennett first observed this in, when the first data on diets around the world were first compiled at the time of World War II. And Bennet's Law is that the poorer you get, the more reliant people are just on the starchy staples.

 So if you go and live with a very, very low income family in Niger or Chad or Mauritania, you know, people are reliant basically on millet and you'd have a little bit of sorghum as well. These are very small grains. They're very gritty to, to the taste, to the mouth they're sort of, um, and they're hard to, hard to harvest, difficult to harvest, difficult to cook, uh, but they're extremely drought tolerant.

Now, if you were in a very forested, rainy place, you would find people relying on planting bananas, and cassava. Those are things that grow well, but those are also just starchy staples, just, just starch basically. And if you were in a very low income place in a rice growing area, people would be eating, uh, just huge amounts of rice.

And it might be just once a day for very low-income people. And then they would have a little bit of dahl, you know, you'd have, if you were in a wheat growing area, you would have, um, you know, a wheat bread, like a chapati bread and, and, and lentils or beans, some kind of, you know, so those cuisines differ greatly in which starchy staple around the world and which compliments to that starchy table around the world.

So from rice and beans to, uh, chapati dahl to, uh, you know, uh, maize porridge that could be called nsima or other terms in different parts of Africa. Yeah, that would be with say a green leafy vegetable, a little bit of vegetable. And that would be a diet that is actually adequate in energy. It's roughly adequate in protein, if it's a cereal grain. It will allow children to grow, not to their full height and not to their full potential, but children will survive. And adults will be anemic. Adults will have high vulnerability to disease, but people will survive and you have whole populations that have eaten like that for centuries.

Shireen: Interesting. And so what policy improvements and government actions are needed here in the U.S. to really increase food affordability, for that population. And it also, if you wouldn't mind, Dr. Masters help us understand the scope of the problem here. What percentage of the population, uh, really fall within, within that category?

William: So in the U.S. there are, so I'm not a specialist on the U.S. and I'm not gonna rattle off data. Um, cause I wouldn't get it right. And my colleagues would be very mad at me because they do get it right. And there are specialists at Tufts University, our specialists on this is Parke Wilde. Um, and most universities have someone who teaches us food.You know, if they have a food program, they would.

Um, but what I can say is that the core programs that we have in the United States, which are starting from, pregnancy, lactation, early childhood, with the WIC program followed by in childhood the very large fraction who are in households supported by SNAP.

And then the, I just heard this statistic that 40% of American children who eat a school meal. At, at age children, um, there are some gaps in this, in continuity, from WIC to SNAP to school meals. Um, the gap particularly at age of four or five is very important because kids graduate out of WIC before they start on school meals.

That make sense? So there's a gap there, which is very important in U.S. policy. There's also a problem with adequacy of these programs. Although the recent increase in SNAP benefits has really closed to, help to close that gap. And I believe adequacy is no longer the issue that it was in the past. Now we're much more concerned about coverage and ensuring that everyone who needs SNAP and WIC actually gets it.

So in these communities where people are marginalized in various ways, it's often difficult to get enrolled and remain enrolled because there are a set of hurdles to demonstrate eligibility where it's just hard to demonstrate people are eligible, but it's difficult to comply with the program. And so we do have people who are eligible as intended by Congress, but then the state administrative bodies that, that run the program may not be able to reach everyone.

So the programs are largely adequate. They just don't have sufficient reach to have coverage of everyone who the intent of the law is, uh, is to support. But then there's, uh, school meals that are pretty good, um, by global standards, uh, of course they could be better to ensure that we have coverage in the summer to show that we have coverage of, uh, of homeless children in schools and so forth.

Uh, still plenty of work to be done there. And then I would add that there's a whole range of food, kind of adjacent policies. So transportation, urban transportation, and rural transportation for that matter is a food policy issue. If people, if the bus routes are not working well, that makes it very hard to put food on the table simply because shopping after work is difficult.

If, uh, and transportation policy is housing policy and vice-versa, so we have a huge housing crisis in America that puts people far from their workplace. And that makes it very, very difficult to feed children well. Not to mention adults themselves.

Shireen: Is there, is there data around the price of a healthy diet, um, that can help us manage, prevent a lot of this, uh, chronic disease, right? Um, such as diabetes, heart disease, obesity in the United States.So those are some pricing, um, numbers that you can share with us.

William: So as soon as you get into dietetics, that's beyond my scope in terms of the customized meals that one would want to be shopping for. What I do know is that the world of people working on low cost diets, United States begins with the Thrifty Food Plan from the United States Department of Agriculture.

So listeners can search Thrifty Food Plan, people who are enrolled in SNAP can speak with people who do SNAP educations, app ed, as it's called, um, and the Thrifty Food Plan published on the USDA website gives you what are the official United States, um, in the views of the U.S. Department of Agriculture, what is an overall healthy diet at low cost, meaning within the budget envelope of SNAP, uh, participants.

Now that is not tailored to medical needs. The world of medically tailored meals is a whole other world beyond my expertise, uh, because it does involve these particular combinations of things. But I can say though, is that the ingredients, the basic elements, if one is willing to just buy generic items, non advertised non-branded, if one is willing to just buy the simple version of the thing.

Yeah, I'd say it's food system is absolutely extraordinary and its ability to deliver those items at low cost and ubiquitous, uh, you know, everywhere in the country. Now there are places that are, were, were very, very difficult to acquire. So rural America is very underserved. Uh, people have really spread out, um, often against their own will, you know, especially native, uh, tribal nations.

Um, you know, they didn't choose to be out there in terms of where, you know, the Navajo nation, for example, you know, people would have to drive, uh, miles and miles and miles to get to a grocery store. But for essentially everyone else, it's just a few miles. And, um, and we do have an amazingly successful system.

The challenge is the overwhelming flood of other things, the overwhelming flood of unhealthy foods that are heavily advertised that are formulated to be so attractive. They're made so convenient and they're really good. That's really hard. So it puts the onus on us every day to do the thing, to do the thing that's a little less fun.

To buy the food that's a little harder to prepare and that's a terrible choice. It doesn't have to be that way. Um, so in other other sectors of the economy and other, every other kind of manufacturing, every other kind of, uh, American industry, you know, the, in what your what's in your hardware store, you know, the ladders, the paint, the scissors, uh, all those things.

Um, people started making them, they would, you know, electrical devices would explode. Um, cars would fall apart. Uh, and those industries and government regulations kind of said, no, you can't make it that way. And we've done that for the food system, taking trans fats out of it, improving it in many, many ways, especially for food safety.

And we have to do that now for nutrition.

Shireen: And so you bring up an interesting point. So the, the amount of advertising that comes, uh, you know, about your ladder and your local sort of hardware store worth as the products that we see in a local grocery store, um, I do want to ask you about why, why is there so much marketing influence to make that?

And if we are talking by regulation, right. Um, and sort of oversight to that, um, it seems like if a car is, uh, you know, for whatever reason, we, we hear all the time, you know, things get, um, uh, you know, they, they, they do callbacks and things like that. Once it is deemed unsafe. Couldn’t a  similar case being made for some of the very unhealthy, um, uh, you know, unhealthy foods that sit on the shelves and grocery stores today, um, to almost recall them, um, from the standpoint of the public health nightmare, uh, that is the chronic diseases that we suffer with today.

William: Absolutely. I think that is the, one of the frontiers of food policy. For your community, for all the communities that care about food, to recognize that food no longer comes directly from farms. Of course it can, but it's a luxury if it does. For most of us, our food comes from manufacturing facilities. Now it's made with ingredients that come from farms, uh, but then those ingredients are transformed and the way they're transformed makes a huge difference to our health.

And we need to think about what is safe, beyond just food safety, in the sense of bacterial contamination, we've successfully gotten out many, many of the chemical contaminants, not all of them, but many of them that were introduced in the sixties and seventies have been removed. The big nutritional success was getting rid of trans fats, which was a transformed ingredient that turned out to be harmful.

And now we have questions about refined grains, about added sugar, about sodium levels. And each of those things could potentially be regulated, just like automobile gas mileage is regulated, just like so many other things.

But it's very hard to do because for decades, we've been told that what we eat is our fault. For decades we've been told if we eat a candy bar, it's our fault. That's not what we're told about many other harmful things. About many other harmful things we're told no, if you're selling that thing, its your fault. And you're not allowed to profit from doing something that's harmful to people. So whether we can get to that point where the food industry, uh, takes responsibility for the consequences of what they sell.

I don't know. It's a big ask for our political system. Now our political system is dealing with many fundamental questions. Should we even be a democracy? Should we even have, um, uh, regulation of the most basic kind or safety nets of the most basic kinds? So there's lots of struggles in America today. Uh, but I think this is certainly one of them that other countries are succeeding with.

So in Europe, in South America, even in South Africa, so, you know, lower income countries are in many ways ahead of us in terms of policing their food industry, just like they police their other industries in the interest of public health.

Shireen: Thank you so much for sharing that, Dr. Masters. Uh, I do have one last question for you before I let you go. Um, at this point, can you tell our listeners how they can connect with you and learn more about your work?

William: Yeah, well, very happy to, uh, to, to communicate by email directly. So I'm william.masters@tufts.edu and on Twitter, uh, we have quite an active food policy, food conversation on Twitter. Um, it's hard to stay safe and sane on Twitter and to avoid the harsher language and just focus on kind of positive communication.

But I think in the food community, there is a positive conversation. Um, so I look forward to seeing some of that, uh, Shireen, with your community, the intersection of your audience with the more academic kind of work we do. Um, and other parts of the food system, it's really exciting to be able to have this broader conversation. Thank you.

Shireen: Thank you so much for your time, Dr. Masters, an absolute pleasure having you on.

William:Thank you Shireen.

Shireen: Thank you. And to our listeners who are listening to this episode, head over to our social media on Facebook, on Instagram and answer this question. What makes the food affordable and healthy? And then also, what are some examples of your favorite healthy and accessible food?

Again, find us on Facebook and Instagram. We're @Yumlish. Find us there and answer this question under this podcast announcement. Dr. Masters, thank you again.

William: Thanks Shireen.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

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