What money won’t buy: Diet quality drops for rural Indonesians as incomes rise

Rice harvest in Dintor village in East Nusa Tenggara, Indonesia. CIFOR/Aulia Erlangga

It might seem logical that as people earn more, they are generally “better off.” And it is certainly true that economic development is often correlated with better outcomes such as health and education.

But money cannot buy everything. Particularly when it comes to healthy foods, evidence from around the world is mixed. We know that people spend money on fatty foods, sugary drinks and snacks that are high in sodium. Having more money does not always lead to healthier food choices.

A new study by researchers at Goettingen University and the Center for International Forestry Research (CIFOR), which examined the relationship between dietary quality, agricultural production diversity and incomes among rural Indonesian households over the period 2000-2015, provides a case in point.

“There is this argument that when  countries develop economically, their populations’ diet quality automatically improves, but what we actually show is that it’s not as straightforward as you might think,” said lead researcher and Goettingen University doctoral researcher Nadjia Mehraban.

Over the past two decades, Indonesia has experienced rapid economic growth and significant poverty reduction, part of which has been driven by a widespread transition from traditional, smaller-scale multi-crop farming techniques to intensified, specialized and commercialized agriculture — with a focus on high-value cash crops like oil palm.

As more and more of Indonesia’s rural mosaic turns to mono-crops, fewer households and communities continue to grow and/or wild-harvest many of the diverse, often nutrient-dense foods that were once important parts of their diets. The conventional economic argument is that with greater cash incomes from agriculture, market access will improve, and rural people will begin purchasing diverse and nourishing food rather than growing or gathering it themselves.

But the sums do not seem to add up. Certainly, economic development in Indonesia has had some positive impacts on diets: undernourishment, for instance, has decreased significantly, from 17 percent of the population in 1999 to 8.3 percent in 2017. However, malnutrition is still a major issue, and stubbornly-high rates of child stunting (36 percent of the population) sit uncomfortably alongside growing issues with overweight and obesity.

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So what is going on? Using a panel data set from the Indonesian Family Life Survey and a sample of 2,785 rural households across the archipelago, the researchers set out to find out more. As a proxy of dietary quality, they analyzed two elements: dietary diversity and the consumption of nutrient-rich food groups.

They found that as production diversity declined — that is, as households switched to more specialized forms of agriculture — dietary quality tended to decline alongside it.

“What made this study special is that we were able to get data on the same households over time,” said CIFOR senior scientist, Amy Ickowitz, co-author of the study.

“We observed them at three points between 2000 and 2015 so we were able to see how what they grew changed as well as what they ate,” she said. “Farmers were growing fewer types of foods over the years and the variety of foods that they were eating also declined. And it was quite striking for some food groups – as people grew fewer fruits, vegetables, and legumes, they ate less of these nutritious foods even as their incomes were rising.”

Consumption of some nutrient-dense food groups — namely animal products such as dairy, eggs and meats — did increase as incomes rose, although that was not a straightforward boon for dietary quality, as overconsumption of these types of foods can lead to issues such as obesity, heart disease and hypertension.

There may be several factors at play here, including the availability and cost of different kinds of food, access to nutrition information and the cultural value placed on various options. The very relatable human foible of not always making the choices that are best for us — particularly when it comes to food — is perhaps relevant here, too.

“Our food choices are not necessarily rational, so that may be where the importance of the food systems, and what is made available to us, comes into play,” said Mehraban. “Sometimes we need some nudging from outside to choose the right thing.”

That is where policymakers and civil society might play a more active role. “I think the work suggests that when you want to improve diets — which is a very important aim because malnutrition has a very high cost for human health — you need to take specific action towards that,” said Mehraban. “It doesn’t necessarily come alongside economic development.”

Rather, developing countries would do well to avoid the diet-related non-communicable diseases that are prevalent in many economically-developed places. “[Western diets] are something of a false direction for economies to follow,” said Mehraban. “And I think for that trend to go in the right direction, we need to target nutrition.”

Ickowitz makes the point that the scientists are not trying to argue that increases in income or access to markets is bad.

“We see the results of our study as simply showing that we cannot just assume that increases in income will take care of all dietary challenges,” she said.

“It seems that when farmers grow fewer fruits and vegetables, they eat these healthy foods less so that policies designed to promote agricultural specialization should be accompanied by policies that promote alternative sources of healthy foods and encourage healthy eating behaviors.”