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A blog about economics in the South Caucasus.

We May Not Be Hungry, but We Are Starving...

It is a well known fact that nearly a half of Georgian population is involved in agriculture, while Georgia imports around 60% of all the food it consumes. High food import share and food security  are important issues for Georgia, widely discussed among the policy makers and in the media. One issue that remains largely in the shadows of public attention is Georgia’s struggle with nutritional deficiencies and unhealthy, undiversified diets. 

Surveys show that bread is one of the main sources of calories in Georgian diets, accounting for as much as 63% of individuals’ caloric intake. This is about twice as much as the benchmark value in developed countries. To compare, in countries such as the United States and the UK the share of dietary energy supply from starchy foods (i.e. bread or equivalent) is about 25-30% of the total caloric intake. In countries like Namibia, India, Shri Lanka the share of energy coming from starchy foods is around 60% (similar to Georgia). In very poor countries, like Mozambique, Bangladesh, Lesotho this share exceeds 80%, which makes their population extremely vulnerable to malnutrition. 

Another measure of national dietary health is the so called Dietary Diversity Score.  The idea behind this measure is that a healthy diet must involve consumption of food products from different food categories, such the 10 categories indicated in the table below.

Table 1. Food categories

1. Cereals 6. Meat
2. Eggs 7. Milk and dairy products
3. Fish and sea products 8. Oils and fats
4. Leguminous 9. Vegetables
5. Nuts and hazelnut 10. Tubers and roots
Source: Based on FAO

The Dietary Diversity Score (DDS) indicates how many of these food groups are consumed on the level of a household, by an individual in a household, and also by different groups of the population - women and children. The table below presents some of the DDS scores for Georgia.

Table 2. Dietary Diversity Scores (DDS) for Georgia

DDS Low wealth tertile Medium wealth tertile High wealth tertile
HDDS (Households) 4.87 5.37 5.71
IDDS (Individuals) 4.77 4.95 4.99
WDDS (Women) 4.58 4.87 4.85
Note: Low DD – consuming 3 food groups out of 10; Medium DD – consuming 4-5 food groups out of 10; High DD – consuming 6 food groups out of 10.
Source: National Nutrition Survey conducted by OXFAM in Georgia and ELKANA



According to the National Nutrition Survey conducted by OXFAM and Elkana, most of Georgian HHs and individuals have medium DDS and consume 4-5 food groups daily. As to children, more than 50% of children aged from 10 to 17 years old consume on average 5 food groups (cereals, oils and fats, vegetables, milk and dairy products, tubers and roots) and only children in high wealth HHs (top 33% of households) consume 7 food groups (fruit and meat in addition to the abovementioned 5 foods). At the same time more than 50% of women in the households consume just 4 food groups (cereals, oils and fats, vegetables, milk and dairy products), even in those families where average number of consumed food groups is 5. This signals that there is an unequal distribution of food in the households of the same tertile, and that women’ diet is less diversified.

According to the same survey, Georgians experience the deficit in essential nutrients. People in Georgia lack access to vitamin-rich fruits, as well as meat and fish containing protein, iron and vitamin A. Only around 35% of population consumes iron rich animal products and consumption is even lower in women and adolescent (33% and 34% respectively). Instead, micro and macro elements are replaced by excess consumption of fats and sugar.


HOW DO PEOPLE CHOOSE WHAT THEY EAT?

For economists people’s choices generally stem from some type of optimizing behavior. In the case of diet, the optimization problem that people solve is that of minimizing cost (or expenditure on food), subject to certain dietary requirements (e.g. consuming a certain number of calories and sufficient amount of nutrients such as iron, protein, vitamin C, etc.). For short-term survival, calorie requirements are more important than nutrient requirements - people need to make sure that they do not starve for energy, but nutrient balance is less crucial in the short run. Thus, poor people, will tend to consume only a few foods to derive the needed amount of calories (recall that in the old days people in Central and Eastern Europe often survived on bread, cheese, and just a few types of vegetables). 

Modern economic research shows that as incomes rise, people will not increase their calorie intake as much as they will increase their general spending on food. In other words, as people become richer, they would prefer to consume a greater variety of foods with the same caloric value.  This finding is consistent with the Georgian data – we can see that high wealth households generally consume more food groups than poor households.


IS IT ONLY ABOUT MONEY?

In Georgia spending on food accounts for 65% of the total spending among poor households. Half of the population spends more than 50% of their income on food and thus sacrifices food diversity. Households with higher income can of course afford more diversified diets; and yet, income is not the only factor affecting what people eat.  Lack of proper information on nutrition, bad habits, and cultural norms are among the factors that influence poor dietary choices among the population. 

In their book “Poor Economics” Abhijit V. Banerjee and Esther Duflo provide very interesting insights into how poor people (for whom food comprises 50% - 70% of total consumption) make decisions about spending on food. Empirical evidence shows that even those people who are not consuming enough food are not willing to spend all extra income on food. If all extra money were devoted to food, then food spending should go up proportionally faster than total spending. However according to the research even among the very poor people, food expenditures increase much less than one for one with the budget.

What is even more interesting is that the money devoted to food is not spent to maximize the calories or micronutrients intake.  Studies in India, Morocco and in some other countries showed that increase in purchasing power does not always result in better nutrition because there are too many other things, the so called “cheap luxuries”, which are competing with food. Examples of cheap luxuries are TVs, mobile phones, computers - things that are considered by many people to be more important than food. Another “competitor” to food is the spending on various social events like funerals, weddings, birthdays etc. Frequently people are forced to spend on these types of events because of the social pressure or a very natural desire to lead an interesting life in a place where there are no movie theaters, concert halls, or even shops.


FOOD AND NUTRITION EDUCATION IS CRUCIAL FOR GEORGIA’S FUTURE

Although the reasons why people do not spend all their income on food (even when they desperately need food) are more or less clear, it is vital to realize that the benefits of good nutrition are particularly important for two categories of people who do not decide what they eat: unborn babies and young children. Good nutrition at early age increases lifetime earnings by making people more productive. 

Current technological advances allow for purchasing of relatively cheap and at the same time nutritional food. Nowadays, in many countries iodized salt or fortified food (read our blog “Mandatory Flour Fortification in Georgia: a Boon or a Burden for the Poor?") is available, but not always demanded by the population. It is critical for the government to understand that proper food policy is not only about ensuring adequate amount of food. The nutritional quality of food is often as important. 

In spite of the fact that Georgia is more developed than many poor countries that are still struggling with hunger and illiteracy, our higher incomes and education levels do not seem to translate into better nutrition for kids and adults. According to FAO, the percentage of kids under five who are stunted (reduced growth rate in human development) in Georgia is as high as 11.3%. This fact signals the lack of attention to investment in proper nutrition, which is as important as investment in education. Both shape the future of the next generation and hence the future of the country.

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Florian Biermann on Wednesday, 04 May 2016 14:55

(1) I am surprised that Georgians are eating that much starchy food. I always thought that countries where people eat a lot of bread have an obesity problem. That does not seem to be the case at all in Georgia __ one sees hardly any obese people (rather the contrary).

(2) An important aspect totally ignored in this article is the usage of food additives. What do I need a high DDS score if I eat my daily vitamin and minteral pills? I am eating a pill that contains not only all vitamins but also all minerals and trace elements in just the right amounts. In addition, I treat myself with a iodine overkill of 150% of the daily allowance (I do not eat fish, and iodine is known to boost ones intelligence ;) ). As a vegetarian, I take particular care that my B12 and iron supply is always warranted (both are abundant in meat), though one has to be careful with that __ it is known that iron, while having beneficial effects, is also carcinogen (https://www.pcrm.org/health/cancer-resources/diet-cancer/nutrition/iron-the-double-edged-sword). I could even do better by adding omega-3 acids (due to the lack of fish). These additives are cheap AND I do not have to adopt a utility-reducing high-DDS diet, forcing me to eat vegetables and fruits ;). Seriously, I think that additives make a lot of sense in the context of this article.

(3) I think it would be good to provide a literature reference for the statement (quote) Good nutrition at early age increases lifetime earnings by making people more productive. (quote)

(1) I am surprised that Georgians are eating that much starchy food. I always thought that countries where people eat a lot of bread have an obesity problem. That does not seem to be the case at all in Georgia __ one sees hardly any obese people (rather the contrary). (2) An important aspect totally ignored in this article is the usage of food additives. What do I need a high DDS score if I eat my daily vitamin and minteral pills? I am eating a pill that contains not only all vitamins but also all minerals and trace elements in just the right amounts. In addition, I treat myself with a iodine overkill of 150% of the daily allowance (I do not eat fish, and iodine is known to boost ones intelligence ;) ). As a vegetarian, I take particular care that my B12 and iron supply is always warranted (both are abundant in meat), though one has to be careful with that __ it is known that iron, while having beneficial effects, is also carcinogen (https://www.pcrm.org/health/cancer-resources/diet-cancer/nutrition/iron-the-double-edged-sword). I could even do better by adding omega-3 acids (due to the lack of fish). These additives are cheap AND I do not have to adopt a utility-reducing high-DDS diet, forcing me to eat vegetables and fruits ;). Seriously, I think that additives make a lot of sense in the context of this article. (3) I think it would be good to provide a literature reference for the statement (quote) Good nutrition at early age increases lifetime earnings by making people more productive. (quote)
Salome Gelashvili on Wednesday, 25 May 2016 16:53

Dear Florian,

Thank you for your comment.

1. The issue of obesity is indeed very interesting and according to WHO: Nationally representative data collected in 2010 show that 58.6% of men and 54.2% of women aged 18–64 years were overweight (based on measured height and weight). The proportion of men and women that were obese was 21.8% and 28.5%, respectively. Adulthood obesity prevalence forecasts (2010–2030) predict that in 2020, 54% of men and 36% of women will be obese. By 2030, the model predicts that 82% of men and 53% of women will be obese. (more on this can be found here: http://www.euro.who.int/__data/assets/pdf_file/0010/243298/Georgia-WHO-Country-Profile.pdf?ua=1 ). So forecasts are not promising.

2.As to the additives, this issue is not ignored in the article and one of the paragraphs of the last section is devoted exactly to this point. Thats where we mention fortified flour and iodized salt. I dont see any big difference between purchasing fortified food or just pills. I think these two are pretty much equivalent to each other. However there is a debate on whether it is better to get vitamins naturally from food or from other sources.

3. Completely agree with this point. There are quite a lot of studies investigating the impact of nutrition on productivity by Scott D Grosse, Kakoli Roy (2008); John Strauss (1986); Christopher Bliss, Nicholas Stern (1978).

Dear Florian, Thank you for your comment. 1. The issue of obesity is indeed very interesting and according to WHO: Nationally representative data collected in 2010 show that 58.6% of men and 54.2% of women aged 18–64 years were overweight (based on measured height and weight). The proportion of men and women that were obese was 21.8% and 28.5%, respectively. Adulthood obesity prevalence forecasts (2010–2030) predict that in 2020, 54% of men and 36% of women will be obese. By 2030, the model predicts that 82% of men and 53% of women will be obese. (more on this can be found here: http://www.euro.who.int/__data/assets/pdf_file/0010/243298/Georgia-WHO-Country-Profile.pdf?ua=1 ). So forecasts are not promising. 2.As to the additives, this issue is not ignored in the article and one of the paragraphs of the last section is devoted exactly to this point. Thats where we mention fortified flour and iodized salt. I dont see any big difference between purchasing fortified food or just pills. I think these two are pretty much equivalent to each other. However there is a debate on whether it is better to get vitamins naturally from food or from other sources. 3. Completely agree with this point. There are quite a lot of studies investigating the impact of nutrition on productivity by Scott D Grosse, Kakoli Roy (2008); John Strauss (1986); Christopher Bliss, Nicholas Stern (1978).
Guest - Yasya on Wednesday, 04 May 2016 15:09

Florian, you are right, food supplements can be very important for poor countries. We discussed this issue in an earlier blog, in the context of flour fortification.
But Omega 3 pills, B12 vitamins and the like are very expensive stuff in Georgia. I doubt they are more economical than having just normal diverse food on the table. Since people will not buy these supplements on their own, providing them for free to children might be a solution, but, I fear, a very expensive solution for the government... Plus, I am also not convinced that the supplements are perfect substitutes for the nutrients coming from natural sources...

Florian, you are right, food supplements can be very important for poor countries. We discussed this issue in an earlier blog, in the context of flour fortification. But Omega 3 pills, B12 vitamins and the like are very expensive stuff in Georgia. I doubt they are more economical than having just normal diverse food on the table. Since people will not buy these supplements on their own, providing them for free to children might be a solution, but, I fear, a very expensive solution for the government... Plus, I am also not convinced that the supplements are perfect substitutes for the nutrients coming from natural sources...
Nodar on Friday, 06 May 2016 14:48

This is nice article and it more or less perfectly describes diversity of food and makes comparison between various countries and various layers of Georgian population. Having medium DDS does not mean we Georgians have good conditions in the sense of food. There are individuals who have highly diversified dietary and there are individuals who have low diversified one and on average we will get medium DDS, so it turns out that there are share of individuals who only relies on bread and other types of food are luxury for them because they have no enough income. However as you mentioned there is one noteworthy fact. This is cheap luxuries and its widespread in Georgia and also in my village. There are lots of families who prefer to have this sort of things rather than healthy food.
The role of cultural norms is huge. If we take a look to Georgian history we will find that historically our ancestor were mainly eaten only meat and bread and the share of other foods in dietary were low. This still affects our choice of dietary.
Moreover, as you mentioned in your comment professor Babych food supplements are expensive and I agree with you that it may not be perfect substitutes and maybe only very low share of Georgian population use them.
Furthermore, quality control needs to be reorganized. There were lots of cases when Georgia imported very low quality food, which was forbidden to use in importer country and even rotten foods. This facts can be seen in Georgian television archives.
So, to sum up we have enough food but we are still starving voluntarily or involuntarily.

This is nice article and it more or less perfectly describes diversity of food and makes comparison between various countries and various layers of Georgian population. Having medium DDS does not mean we Georgians have good conditions in the sense of food. There are individuals who have highly diversified dietary and there are individuals who have low diversified one and on average we will get medium DDS, so it turns out that there are share of individuals who only relies on bread and other types of food are luxury for them because they have no enough income. However as you mentioned there is one noteworthy fact. This is cheap luxuries and its widespread in Georgia and also in my village. There are lots of families who prefer to have this sort of things rather than healthy food. The role of cultural norms is huge. If we take a look to Georgian history we will find that historically our ancestor were mainly eaten only meat and bread and the share of other foods in dietary were low. This still affects our choice of dietary. Moreover, as you mentioned in your comment professor Babych food supplements are expensive and I agree with you that it may not be perfect substitutes and maybe only very low share of Georgian population use them. Furthermore, quality control needs to be reorganized. There were lots of cases when Georgia imported very low quality food, which was forbidden to use in importer country and even rotten foods. This facts can be seen in Georgian television archives. So, to sum up we have enough food but we are still starving voluntarily or involuntarily.
Salome Gelashvili on Wednesday, 25 May 2016 17:02

Dear Nodar,

Thank you for your comment.

I think that the point related to the cultural norms and habits is very important. In many cases money is not the most important factor determining the diet. Many parents bring their kids to McDonalds in spite of the fact that food there is very unhealthy and quite expensive. This kind of behavior develops unhealthy eating habits in kinds in early childhood and for some reason parents support this kind of behavior and then kids suffer from various health related issues.

Dear Nodar, Thank you for your comment. I think that the point related to the cultural norms and habits is very important. In many cases money is not the most important factor determining the diet. Many parents bring their kids to McDonalds in spite of the fact that food there is very unhealthy and quite expensive. This kind of behavior develops unhealthy eating habits in kinds in early childhood and for some reason parents support this kind of behavior and then kids suffer from various health related issues.
Pati Mamardashvili on Tuesday, 10 May 2016 17:47

Thanks for addressing this issue. Food diversity is important indeed.
Why do you think that the spending on various social events like funerals, weddings and birthdays is another “competitor” to food spending? Food consumed on these events is highly diversified, isn’t it?
I wonder if the diversity of food consumed on different social events are considered in that National Nutrition Survey. Usually, dietary diversity questionnaires ask respondents to list food for breakfast, lunch, dinner as well as snacks. So, it excludes foods purchased and eaten outside the home. Since Georgians like weddings, birthdays (and also funerals!) very much the diversity of our food consumption might not be as bad as argued in the results of this survey.

Thanks for addressing this issue. Food diversity is important indeed. Why do you think that the spending on various social events like funerals, weddings and birthdays is another “competitor” to food spending? Food consumed on these events is highly diversified, isn’t it? I wonder if the diversity of food consumed on different social events are considered in that National Nutrition Survey. Usually, dietary diversity questionnaires ask respondents to list food for breakfast, lunch, dinner as well as snacks. So, it excludes foods purchased and eaten outside the home. Since Georgians like weddings, birthdays (and also funerals!) very much the diversity of our food consumption might not be as bad as argued in the results of this survey.
Guest - Yasya on Wednesday, 11 May 2016 12:35

Thats a good point, Pati! But Im just curious - how many weddings, birthdays and funerals does an average Georgian attend per month? Do children also attend these functions? You may be right that nutrition diversity is somewhat understated in the survey.

Thats a good point, Pati! But Im just curious - how many weddings, birthdays and funerals does an average Georgian attend per month? Do children also attend these functions? You may be right that nutrition diversity is somewhat understated in the survey.
Salome Gelashvili on Wednesday, 25 May 2016 17:23

Dear Pati,

Thank for reading our blog.

I agree with Yasya that frequency of such events really matters. Frequency in my opinion is quite low but costs (spending) are high. People might have one wedding and spend years to repay the loan taken to have this wedding. Which means that during the years after wedding one would have less money for food because some portion of income goes to repay the loan. Even in case if there is no loan, high spending on such events automatically reduces spending on food.

Apart from this at various social gatherings, people usually eat what they like the most and that does not necessarily guarantee diversity and healthy food. The idea is to have food from various food categories not just various foods.

As to the questionnaire for measuring dietary diversity, it includes foods eaten outside home. You can find the questions here: http://www.fao.org/fileadmin/user_upload/eufao-fsi4dm/doc-training/hdd.pdf .

Dear Pati, Thank for reading our blog. I agree with Yasya that frequency of such events really matters. Frequency in my opinion is quite low but costs (spending) are high. People might have one wedding and spend years to repay the loan taken to have this wedding. Which means that during the years after wedding one would have less money for food because some portion of income goes to repay the loan. Even in case if there is no loan, high spending on such events automatically reduces spending on food. Apart from this at various social gatherings, people usually eat what they like the most and that does not necessarily guarantee diversity and healthy food. The idea is to have food from various food categories not just various foods. As to the questionnaire for measuring dietary diversity, it includes foods eaten outside home. You can find the questions here: http://www.fao.org/fileadmin/user_upload/eufao-fsi4dm/doc-training/hdd.pdf .
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