Eye on Global Health

By Mansoor Kali

The food aisle has become a front line for public health, where cheap calories compete against chronic diseases. Why are unhealthy foods so cheap while nutritious options stay out of reach for many families? This article explores how global food pricing policies are influencing children’s health, and what can be done about it.

Figure 1. © freshidea AdobeStock_476362981

The other day, I walked into a store. The first thing I saw was a wall of soda bottles, “two for $5.” Next to them, bags of chips with neon stickers advertising “buy one, get one free.” The fruit cups in the refrigerated section were half the size and twice the price. I hesitated for a second before grabbing the saltier, cheaper, sugarier option.

For millions around the world, this is not just an occasional compromise, it is a routine, and for children and teenagers, who often have less autonomy over what food is available to them, it sets the stage for chronic diseases.

This simple moment, one that plays out every single day in school canteens and supermarkets across the globe, is the consequence of deep, systemic pricing policies that favor ultra-processed foods over nutritious ones. The ripple effects are impacting public health globally.

Cheap Calories, Expensive Nutrition

Globally, unhealthy diets are among the leading contributors to non-communicable diseases such as cardiovascular illness, diabetes, and obesity. It’s no coincidence that unhealthy diets are often the cheapest options. A widely cited meta-analysis published in BMJ Open found that, on average, healthier diets cost about $1.50 more per individual per day than less healthy diets (1). That may sound small, but over a long period of time, particularly for low-income households and larger families, it translates into a significant barrier.

In low- and middle-income countries (LMICs), such barriers are even more pronounced. According to the Food and Agriculture Organization (FAO), over 3 billion people globally can not afford a healthy meal (2). In parts of South Asia and sub-Saharan Africa, the cost of meeting minimum nutrition standards can consume 70% or more of a household’s income.

Even in high-income nations like the UK and the United States, income-based disparities in diet are severe. In the U.S., households participating in the Supplemental Nutrition Assistance Program (SNAP) tend to purchase significantly more sugar-sweetened foods and beverages and fewer vegetables and fruits compared to higher-income households (3).

Why the Price Gap?

The pricing gap between unhealthy and healthy food is not only about market demand, it is deeply rooted in policy. Since the mid-20th century, agricultural subsidies in regions like the EU and the U.S. have disproportionately favored commodity crops such as wheat, soy, and corn. These crops are used to create the cheap ingredients, like starches, refined oils, and corn syrup, that dominate ultra-processed foods. In contrast, healthier options like lean meats, legumes, vegetables, and fruits receive little to no subsidy support, making them comparatively less accessible and more expensive.

This imbalance has had a significant impact on public health. A study published in JAMA Internal Medicine found that nearly 60% of calories consumed by U.S. adults came from subsidized food ingredients, most of which were found in fast food or processed items (4). The result is a marketplace where the most nutritionally deficient foods are also the most widely available and cheapest, reinforcing unhealthy eating patterns on a systemic level.

Ultra-Processed Foods and a Global Health Burden

The affordability of ultra-processed foods (UPFs) is a major driver of rising rates of childhood obesity and diet-driven diseases around the world. UPFs, products that are industrially formulated with minimal whole food content, such as whole grains, legumes or fresh vegetables and instead packed with multiple additives like emulsifiers, artificial flavorings, and high-fructose corn syrup, are not just cheaper but also aggressively marketed. Such ingredients enhance texture, taste, and shelf life but offer little to no nutritional value, making UPFs both harmful and appealing when they dominate everyday diets.

Research published in The Lancet Regional Health – Americas highlights how increased consumption of UPFs is linked to rising type 2 diabetes and obesity rates in countries undergoing rapid nutrition transitions, such as Columbia, Mexico, and Brazil (5). Similarly, findings in Preventing Chronic Disease show that the affordability of sugar-sweetened beverages (SSBs) increased globally between 1990 and 2016, specifically in LMICs, where affordability rose by an average of 8.76% annually, compared to 1.96% in high-income countries, making SSBs increasingly accessible to a growing segment of the population (6).

For children, whose food choices are usually determined by school offerings, advertising, and availability, this environment is extremely dangerous.

The Role of Marketing: Cheap and Loud

Pricing is only half the story. The other half revolves around the marketing engine that drives food preference, especially among young people.

Globally, beverage and food companies spend billions annually on marketing strategies targeting children. These include celebrity endorsements, cartoon characters, social media influencers, and digital games. According to a review in Appetite, children exposed to food advertisements are significantly more likely to request, choose, and consume advertised foods, particularly those high in salt, sugar, and fat (7).

This targeting is not random. Companies strategically push unhealthy foods in lower-income neighborhoods and developing markets, where laws and regulations are often weaker and consumers are more price-sensitive.

The outcome? Children living in poverty are not only more likely to consume ultra-processed foods, they are also more likely to become lifelong consumers of them.

Policy That Works: Taxes, School Meals, and Subsidies

While the challenges are considerable, so too are the opportunities for effective intervention.

In 2014, Mexico implemented a national soda tax. Within two years, sugary drink consumption dropped by almost 8%, with the largest reductions seen among lower-income households (8). This success has prompted similar policies in South Africa, Chile, and the UK.

Chile has gone a step further. In addition to taxing sugary drinks, it introduced front-of-package warning labels and banned the use of cartoon characters on unhealthy foods. Mexico has followed suit, introducing its own mandatory black octagon warning labels in October 2020 and later banning the sale of labeled “junk food” in schools effective March 2025 (9)(10). Early evaluations show that these policies significantly decrease purchases of products high in salt, sugar, and saturated fats, especially among families with children. In Chile, household purchases of labeled products dropped notably after policy implementation: 23% less sodium, 36.8% less sugar, 16% less saturated fat, and 23% fewer total calories compared to expected levels without the law (11). Such reductions were observed across socioeconomic groups and reflect changes in school environments, consumer behavior, industry reformulation, and marketing exposure.

Positive incentives are equally powerful. The U.S. Healthy Incentives Pilot (HIP) provided SNAP recipients with a 30% refund when purchasing vegetables and fruits, resulting in a 25% increase in produce consumption, demonstrating that cost remains a core barrier (12). By reducing the cost of healthier options, such programs empower low-income families to make more nutritious decisions and help normalize healthier diets over time.

School meals are another vital policy lever. Programs that provide subsidized or free meals, especially those that emphasize local, fresh foods, can reshape children’s eating habits and improve health outcomes. Brazil’s national school feeding program, which sources 30% of food directly from family farmers, has become a global model (13). This approach not only improves nutrition and food diversity for students but also supports small-scale farmers and strengthens local food systems through comprehensive and integrated policy design.

Figure 2. Image from 123rf

What Should Global Health Advocates Do?

Global health organizations, including WHO and UNICEF, as well as international frameworks like the UN Global Strategy on Diet, Physical Activity and Health, recommend a mix of market, regulatory, and educational interventions to improve dietary outcomes, particularly for children (14). 

These include:

• Strengthening public procurement policies (e.g., school meals)
• Banning or regulating child-targeted marketing of unhealthy products
• Subsidizing healthy foods, particularly for vulnerable populations
• Mandating clear, easy-to-read front-of-pack nutrition labeling
• Implementing taxes on junk food and sugary drinks

These policies not only improve health, they also promote equity by making healthy drinks and foods accessible to all, regardless of income.

Back to the Store

Imagine that same store a year from now, but this time, the fruit cups are subsidized and cost less than the cookies. The soda bottles carry clear warning labels, and water is promoted with loyalty points. The shelves include fresh options at the entrance, not just buried in the back. What once felt like a tough choice is now the easy one.

Children deserve to grow up in environments that nurture their health, not undermine it. The solution isn’t more personal responsibility, it’s corporate accountability, pricing equity, and policy reform.

In the fight for global health, the front line might just be the checkout aisle.

References

1. Rao M, Afshin A, Singh G, Mozaffarian D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open. 2013;3(12):e004277.
   
2. FAO, IFAD, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World 2023. https://www.fao.org/documents/card/en/c/CC3017EN
   
3. Bleich SN, Vercammen KA, Koma JW, Li Z. Trends in beverage consumption among children and adults, 2003–2014. Pediatrics. 2018;141(6):e20173459.
   
4. Siegel KR, et al. The contribution of subsidized food commodities to total energy intake among US adults. JAMA Intern Med. 2016;176(8):1124-1132.
   
5. Popkin BM, Reardon T, Kenan WR. Obesity and the food system transformation in Latin America. Lancet Reg Health Am. 2020;1:100003.

6. Blecher E, Liber AC, Drope JM, Nguyen B, Stoklosa M. Global tends in the affordability of sugar-sweetened beverages, 1990-2016. Prev Chronic Dis. 2017;14:E37. doi:10.5888/pcd14.160406
   
7. Cairns G, Angus K, Hastings G, Caraher M. Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. Appetite. 2013;62:209–215.
   
8. Colchero MA, Rivera-Dommarco J, Popkin BM, Ng SW. In Mexico, evidence of sustained consumer response two years after implementing a sugar-sweetened beverage tax. Health Aff. 2017;36(3):564–571.

9. Pan American Health Organizations. Front-of-package labeling advances in the Americas. 2020 Sep 29. Available from: https://www.paho.org/en/news/29-9-2020-front-package-labeling-advances-americas 

10. Stevenson M. Mexico bans junk food sales in schools in its latest salvo against child obesity. Associated Press. 2025 Mar 5. Available from: https://apnews.com/article/c22fa1e1d2b483890142355cb1163520 

11. Tallie LS, Bercholz M, Popkin B, Rebolledo N, Reyes M, Corvalán C. Decreases in purchases of energy, sodium, sugar, and saturated fat 3 years after implementation of the Chilean food labeling and marketing law: An interrupted time series analysis. PloS Med. 2024;21(9):e1004463. doi: 10.1371/journal.pmed.1004463. PMID: 39331649; PMCID: PMC11432892
    
12. Bartlett S, Klerman J, Olsho L, et al. Evaluation of the Healthy Incentives Pilot (HIP): Final Report. USDA Food and Nutrition Service; 2014.

13. Jekums A. The Powerful Coaction of Brazil’s National School Feeding Program. Ryerson Journal of Policy Studies.

1. World Health Organization. Policies to protect children from the harmful impact of food marketing: WHO guideline. Geneva: World Health Organization; 2023. Available from: https://www.who.int/publications/i/item/9789240075412