The 2020 State of Food and Nutrition Security in the World (SOFI) estimates that close to 690 million people, or about 9% of the world population, did not have access to enough food or were “undernourished” in 2019. These statistics, however, assume that having enough calories is the only thing that human beings need to live a healthy and active life. This is not the case. To improve the accuracy of the information presented for the first time, the SOFI report also includes new measures of food security, which show that up to 2 billion people did not have access to safe, nutritious, and sufficient food in 2019 and 3 billion could not afford a healthy diet. These new measures are much more in line with the 1996 World Food Summit comprehensive and widely endorsed definition of food security, which states that “food security exists when all people, at all times, have physical and economic access to sufficient, safe, and nutritious foods that meets their dietary needs and food preferences for an active and healthy life.” Clearly, food security measures based only on quantity of food grossly underestimate the magnitude and severity of the problem and reflect only one of the many aspects of what food security really entails.

Food security in urban areas

Urban areas have traditionally been perceived as having less problems of food insecurity than rural areas, and this could be true if indeed only access to enough food mattered. Food in urban areas is generally plentiful and available in a variety of forms from fresh to prepared to packaged, in a number of retail outlets from traditional markets to corner shops to high-end supermarkets, and from local and international formal and informal restaurants and fast food chains. But abundance of food does not mean that everyone has equal access to nutritious foods and to safe, diverse, healthy, and affordable diets.

Urban areas are most afflicted by profound inequalities stemming from differences between socioeconomic groups, ethnicity, migratory status, location of residence (slums or formal settlements), city size, and a host of other factors. In India, we find that the nutritional status of poor slum dwellers is similar to those of rural populations, challenging the myth that urban dwellers are generally better off than their rural counterparts. In a forthcoming paper, our team shows that child stunting (low height for age), for example, is approximately 40% in both urban slums and rural areas of India, whereas adult overweight is worse in urban slums, affecting 21% of adults compared to 15% in rural areas. This double burden of malnutrition, which is characterized by the coexistence of problems of undernutrition along with overweight and obesity, is severe in urban areas because of the rapid shifts in dietary patterns that result from exposure to the urban food environment, including abundance and excessive promotion of fast food, fried snacks, sugar-sweetened beverages, and ultra-processed foods.

There is no global data on food security disaggregated by urban and rural areas, although many claim that food insecurity afflicts more rural than urban residents. In fact, the unique characteristics of life in urban areas makes the urban poor particularly vulnerable to food insecurity. Urban dwellers are almost entirely dependent on the cash economy and therefore need stable employment and income for their food needs, whereas many rural households have access to land and grow a significant proportion of the food they consume. An analysis of 20 low- and middle-income countries shows that urban households spend on average more than 50% of their budget on food and up to 75% in the poorest countries. This dependence on cash for food means that stable income and food affordability are the two most important determinants of food security and access to healthy diets in urban areas.

The main drivers of food insecurity in urban areas

For the urban poor, the challenges of achieving food security and accessing a healthy diet arise from some of the specific features of urban life. First, although income is critically important for food security and healthy diets, many poor urban households rely on low paying and insecure jobs in the informal sector. Women are also more likely to be actively engaged in the labor force and work away from home for long hours, often in jobs that are not amenable to taking a young child along. Because they may not have access to extended family or social networks, especially if they are new migrants to the city, they have to hire substitute childcare, which places an even greater financial burden on their family. This may also affect the quality of childcare and their children’s well-being, diets, and nutrition and health status.

With women spending long hours at work and commuting to and from work, their time for household chores, cooking, and childcare becomes scarce. Moreover, the precarious conditions in which many of the poor live in urban areas means they have limited access to kitchen or cooking equipment, electricity, refrigeration, and safe water, which prevents them from storing food or preparing meals for their family. Time scarcity and physical constraints results in many poor households opting for convenience and relying on ready-to-eat, prepared, and often packaged ultra-processed foods. Such meals are cheaper but of poorer nutritional quality than traditional diets, which take longer time to prepare. Eating out and purchasing meals from informal and non-regulated street vendors and informal restaurants also increases food safety risks and related illness.

In addition to income and food affordability constraints, the urban poor generally have less access to both formal and informal social protection support, such as cash or food transfer programs. Global evidence from 100 countries shows that poor urban households are less likely to be covered by social safety net programs; in middle-income countries, the urban-rural gap was found to be as high as 24 percentage points. Poor urban households also often lack potential financial or food support from extended family networks or informal friends or neighbor groups, especially in unsafe, high-crime environments. This lack of public or social support makes urban dwellers particularly vulnerable to income and food price shocks.

The consequences of severe food insecurity, and the coping strategies that the urban poor are often forced to adopt in times of crisis, can be extremely damaging for their children’s nutrition, health, and cognitive development in the short term. In the long term, this puts them at a greater risk of poor schooling performance, lower economic productivity, and increased susceptibility to overweight or obesity in adulthood. For older children and adults in households whose coping strategies involve shifting to cheaper sources of calories, including high consumption of ultra-processed foods, the resulting diets, which are low in protein and micronutrients and high in saturated fats, calories, sugar, and salt, increase their risks of overweight and obesity and diet-related non-communicable diseases like diabetes, coronary heart diseases, and several types of cancer.

For the urban poor, these health and nutrition challenges are also compounded by a lack of access to health care, safe water and sanitation facilities, and a greater exposure to contaminants and air pollution. Once again, these conditions affect slum dwellers disproportionately and deepen inequalities in health and nutrition outcomes.

Supporting the urban poor

With urbanization intensifying in Africa and Asia, the projected population growth is expected to add 2.8 billion urban residents by 2050. Thus, the challenge of addressing urban food security and healthy diets can no longer be ignored. The unique features and drivers of urban food insecurity and unhealthy diets and the vast inequalities within urban areas require tailored programs and policies that specifically tackle the needs of the urban poor. The Covid-19 pandemic and the related economic crisis have disproportionately affected urban populations, especially the previously non-poor who, at least in Africa, are suffering the greatest income losses. Immediate attention needs to be directed to urban populations, with a focus on the following priority areas:

1. Leverage food systems to increase availability, access, and affordability of nutritious foods, and consumption by the urban poor. Examples include:

• Strengthen urban-rural linkages and support value chains for perishable, high-value nutritious foods (including fruits and vegetables, dairy, poultry, and fish) to boost consumption of these foods by the urban poor;
• Support women and men in the informal agriculture and food sector through trainings, financial support, and infrastructure to improve hygiene, food safety, and the nutritional value of the foods they sell; and
• Where policies allow, support or expand urban agriculture to increase the urban poor’s consumption of a diversity of nutritious food, such as fruits and vegetables;

2. Tailor and target social safety nets to support the livelihoods, income, food security, and healthy diets of urban dwellers and protect them from seasonality, climate, health, and other shocks and vulnerabilities. Examples include:

• Providing targeted cash, food transfers, or vouchers for nutritious foods to poor urban households; and
• Providing free healthy school meals and educating school children in healthy diets and lifestyles, especially those living in urban slums and other poor urban environments.

3. Design and target education campaigns combining mass media and targeted messaging through mobile technologies and promotion in markets and other retails frequented by urban poor households to convey key messages about nutritious foods and healthy diets and lifestyle, and to reverse current trends showing rapid rises in consumption of cheap calories from unhealthy ultra-processed foods.

4. Address inequalities in the access of poor urban dwellers to services, including health care, water, sanitation, waste removal, and electricity services, and lift the access and utilization barriers faced by urban dwellers where services are available.

In order to design successful programs and policies that address the realities of urban life and the specific needs of the most vulnerable, investments in research are needed to characterize the specific challenges and the opportunities to support the urban poor and to test solutions that can be scaled up. The current state of evidence on urban food security, diets, nutrition, and health and their drivers is shockingly outdated and scattered. The existing evidence cannot provide the type of information needed to guide policy. In this area in particular, action is needed urgently.

Marie Ruel is Director of IFPRI’s Poverty, Health, and Nutrition Division and a member of the management committee of the IFPRI-led CGIAR Research Program on Agriculture for Nutrition and Health (A4NH). This post first appeared as part of the Center for Strategic and International Studies Reset the Table essay series.