Balancing a sustained pursuit of nutrition, health, affordability and climate goals: exploring the case of Indonesia

Abstract

Background: To guide the transformation of food systems to provide for healthy and sustainable diets, countries need to assess their current diet and food supply in comparison to nutrition, health, affordability, and environmental goals.

Objectives: We sought to compare Indonesia's food utilization to diets optimized for nutritional value and cost and to diets that are increasingly plant-based in order to meet further health and environmental goals, including the EAT-Lancet planetary health diet, to explore whether multiple goals could be achieved simultaneously.

Methods: We compared 13 dietary scenarios (2 current, 7 optimized, 3 increasingly plant-based, 1 EAT-Lancet) for nutrient content, cost, greenhouse gas emissions (GHGe), and water footprints, using the FAO food balance sheet, Indonesia Household Income and Expenditure Survey household food expenditure, food composition, life cycle assessment, food losses, and trade data.

Results: The diversity of modeled scenarios was higher than that of current consumption, reflecting nutritional deficiencies underlying Indonesia's burden of different forms of malnutrition. Nutrient intake targets were met best by nutrient- and cost-optimized diets, followed by the EAT-Lancet diet. Those diets also had high GHGe, although less than 40% of a scenario in which Indonesia would adopt a typical high-income country's diet. Only the low food chain diet had a GHGe below the 2050 target set by the EAT-Lancet commission. Its nutrient content was comparable to that of a no-dairy diet, slightly above those of fish-and-poultry and current diets, and somewhat below those of the EAT-Lancet diets. To meet nutrient needs, some animal-source foods had to be included. Costs of all except the optimized diets were above the current national average food expenditure. No scenario met all goals simultaneously.

Conclusions: Indonesia's consumption of rice and unhealthy foods should decrease; food production, trade, and processing should prioritize diversification, (bio)fortification, and limiting environmental impacts; and consumer and institutional demands for healthy, nutritious, and sustainable foods should be stimulated. More granular data and tools are required to develop and assess more detailed scenarios to achieve multiple goals simultaneously.

Keywords: EAT-Lancet diet; Indonesia; affordability; climate change; diet and climate; food expenditure; greenhouse gas emissions; nutritional value; sustainable healthy diets; water footprint.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Figures

FIGURE 1

Energy content and contributions from different food groups for the current and modeled diets (kcal/cap/d), (A) for an average individual and modeled household average and (B) optimized for specific individuals. *Optimized to meet nutrient requirements at the lowest cost.

FIGURE 2

Protein content and contributions from different food groups for the current and modeled diets (g/cap/d), (A) for an average individual and modeled household average and (B) optimized for specific individuals. *Optimized to meet nutrient requirements at the lowest cost.

FIGURE 3

Costs and contributions from different food groups for the current and modeled diets (Rupiah/cap/d), (A) for an average individual and modeled household average and (B) optimized for specific individuals. Dashed lines indicate the current national food expenditure on average and in urban and rural areas (Indonesia Household Income and Expenditure Survey). *Optimized to meet nutrient requirements at the lowest cost.

FIGURE 4

Total greenhouse gas emissions and contributions from different food groups for the current and modeled diets (kg carbon dioxide equivalents/cap/y), (A) for an average individual and modeled household average and (B) optimized for specific individuals, including IQRs. †The 2050 target was adapted from Willett et al. (5): 519 kg carbon dioxide equivalents/cap/y; uncertainty range, 483–555. *Optimized to meet nutrient requirements at the lowest cost.

FIGURE 5

Amounts of energy provided and proportions of recommended intakes for different nutrients [nutrient reference values from Codex Alimentarius (28)] met by the different modeled diets. *Optimized to meet nutrient requirements at the lowest cost. EAA, essential amino acid; Vit, vitamin.

FIGURE 6

Total per capita blue water (surface and ground water, for irrigation) and green water (from rainfall) footprints for the current and modeled diets (1000 L/cap/y), including IQRs. †The 2050 target was adapted from Willett et al (5): 256,804 L/capita/year; uncertainty range, 102,722–410,887. *Optimized to meet nutrient requirements at the lowest cost.

FIGURE 7

Each diet's score compared to the targets for GHGe, blue WF (surface and ground water, for irrigation), mean nutrient adequacy, and aggregate nutrient score and to the current average food expenditure for cost. A score higher on an axis is better (note that for nutrient scores the target is at the top, with all lower scores being suboptimal, whereas for blue WF all scores are better than the target level). *Optimized to meet nutrient requirements at the lowest cost. GHGe, greenhouse gas emissions; WF, water footprint.