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Urban Malnutrition
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URBAN FOOD Looking for food among Asia’s proliferating street vendors
In Asia’s big cities, obesity is a paradox, yet a growing problem. The overweight often live alongside the underweight, sometimes in the same household. Diseases like diabetes, frequently the result of high-fat diets that lead to obesity, are rising as urbanization brings major dietary changes.
As people flock to urban areas such as Jakarta or Manila, many are abandoning traditional fare for processed food and street stalls that are quick and cheap, but often deficient in essential nutrients.
Development planners have been slow to react to this “nutrition transition.” Study is needed to determine just what people are eating, and how to improve their diets affordably. And solutions will have to incorporate urban realities, such as reliance on processed food and on fortifying common food choices with vitamins and minerals.
Asia is home to the biggest number of the world’s malnourished children. In many countries, like the Philippines, more than 50% of malnourished children live in urban areas.
Indonesia shows the gravity of the problem. There, 30% of children aged below 5 are malnourished, the highest rate in this age group in Southeast Asia. They are lacking basic nutrients, such as vitamin A, iodine, and iron that can contribute to the increased incidence of disease, retardation, brain damage, and death.
About 18% of Indonesia’s 210 million people are poor, and more than half of them will live in urban areas by 2010. Pockets of low nutrition status are evident across the nation, and micronutrient deficiencies have led to unacceptably high levels of maternal, infant, and child mortality, especially among the poor.
In the country’s urban slum areas, more and more young women are eating inferior-quality processed food and snacks, raising the incidence of obesity and diet-related diseases.
Part of the problem is the cost of urban food. Recent surveys in four Javanese cities show that the poor spend more than 75% of their income to feed themselves. They are more likely, therefore, to buy cheaper food from street vendors than to prepare it themselves. Yet, from these foods, they may get only 70–75% of the minimum daily requirement for good nutrition.
"Fortifying processed foods, by adding vitamins, minerals, and calories, can be one of the most important benefits for populations shifting from eating self-produced to processed foods"
Estimates suggest that the recommended daily energy intake can be met for about $1 a day. Although nutritional studies on street food consumption are still under way, there is evidence that some of these foods can offer nutritionally balanced meals.
However, many cannot. And for that reason, fortification with micronutrients may be an answer.
Adding vitamins, minerals, and calories can be one of the most important ways to help people shifting from self-produced to processed foods. Fortification—such as by salt iodization or fortification of wheat flour with a premix of iron, zinc, folic acid, and vitamin B—is important in Indonesia’s fight against micronutrient deficiencies.
What’s more, food fortification is often more cost-effective than other strategies, such as supplementary feeding. It has already been identified as a key element in national nutrition strategies, such as in Indonesia and other Asian countries including the Philippines.
However, there is still a lack of data on, and analysis of, what kind of food the urban poor consume. It is known that the rice-based diet of the urban poor is energy-deficient, unbalanced, and lacking essential micronutrients, particularly iron.
It is also clear that the consumption of wheat flour, especially instant noodles, is growing, and there are food products such as iodized salt and iron-fortified wheat flour available. It is still uncertain, nonetheless, just how affordable they are for the poor.
To fight malnutrition among the urban poor, studies must be done to better understand these issues. Researchers need to identify “pro-poor” food vehicles, such as rice, oil, and condiments that can be fortified at an affordable price.
Other tools should include better education for the poor about good nutrition, the benefits of fortified food, and how to make a nutritious diet affordable.
To date, in Indonesia and other parts of Asia, there has been no systematic effort to respond adequately to the “nutri-tion transition” among the urban poor. Current nutrition programs have focused on rural malnutrition and are not effective in urban settings where malnutrition differs significantly because of household dependence on food prices, cash income, and reliance on street foods.
CHEAP EATS The poor are more likely to buy cheaper processed foods
Policymakers need to synchronize food, nutrition, and poverty reduction programs to respond to the challenge and forestall higher future health-care costs and a loss of productivity as a result of diet-related diseases.
Better regulations for food vendors, accompanied by improved enforcement, could improve nutrition through better preparation and hygiene.
Stronger public-private alliances have to be built to expand food fortification to commodities, which the poor can afford to buy. Public policies are required that promote affordability for fortified food products, and promote their health benefit.
To address these concerns in a comprehensive manner, the Asian Development Bank approved a $500,000 technical assistance grant in June 2003 to help the Government of Indonesia design a model of public-private partnership for improved nutrition management in North Jakarta, Medan, and Makassar, and provided policy recommendations for the new national nutrition strategy.
This new approach to improving urban nutrition has been identified as a key pillar in fighting malnutrition in Indonesia. The Government has also sought additional technical assistance to prepare an urban nutrition project for low-income communities in six cities by 2005.
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