BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has severely affected global food security, but analyses of the impact of the pandemic on the cost and affordability of a healthy diet are limited. This study examines the immediate effect of the COVID-19 pandemic on the cost and affordability of a healthy diet among urban households in Bangkok, Thailand and Manila, the Philippines.MethodsWe use official food price and household income and food expenditure data from the national statistics offices. The cost of recommended diet (CoRD) method was used to assess the minimum cost of a healthy diet, following the healthy diet recommendations provided in the national food-based dietary guidelines of the specific countries. Regression discontinuity design was used to determine the COVID-19 effect on food prices and scenario analysis was used to determine the effect of reduced food budgets with and without government relief programs. ResultsThe results show that the average cost of the recommended diet was US$ 0.67 per person/day in Bangkok and US$ 1.44 in Manila immediately before the start of the pandemic. This diet is generally affordable for all households in Bangkok, but only for 40% of households (5.42 million people) in Manila, indicating much higher poverty in the latter. The pandemic and associated government measures, decreased the cost of the recommended diet with 3% in Bangkok (p=0.002) but not in Manila (p=0.298). Assuming contractions in people’s food budgets of 15-20%, the recommended diet would become unaffordable for 1.3-2.3 million people in Bangkok and 5.97 to 7.40 million people in Manila. In Bangkok, government relief largely compensated for this loss, but relief payments in Manila were not enough to compensate the effect. ConclusionThese results show that the main effect of the COVID-19 pandemic on the affordability of healthy diets was through the effect on incomes of the poor rather than through prices. The government relief measures should be targeted to low-income beneficiaries to have adequate resources to purchase a healthy diet.

Background The coronavirus disease 2019 (COVID-19) pandemic severely affected global food security, but analyses of its impact on the cost and affordability of a healthy diet are limited. This study examines the immediate effect of the COVID-19 pandemic on the cost and affordability of a healthy diet among urban households in Bangkok, Thailand and Manila, the Philippines. Methods We used official food price and household income and food expenditure data from the national statistics offices. The cost of recommended diet (CoRD) method was employed to assess the minimum cost of a healthy diet, following the healthy diet recommendations provided in the national food-based dietary guidelines of the specific countries. Regression discontinuity design was estimated to determine the COVID-19 effect on food prices and scenario analysis done to determine the effect of reduced food budgets with and without government relief programs. Results The results show that the average cost of the recommended diet was US$ 1.55 per person/day in Bangkok and US$ 3.76 in Manila (2019 prices in purchasing power parities) immediately before the pandemic. This diet is generally affordable for all households in Bangkok, but only for 37% of households (4.98 million people) in Manila, indicating much higher poverty in the latter. The pandemic and associated government measures decreased the cost of the recommended diet with 6.5% in Bangkok (p = 0.001) but not in Manila (p = 0.167). Assuming contractions in people’s food budgets of 15–20%, the recommended diet became unaffordable for 0.08–0.12 million people in Bangkok and 6.32–7.73 million people in Manila during the pandemic. Government relief largely compensated for this loss in Bangkok, but relief payments in Manila were not enough to compensate the effect. Conclusion These results show that the main effect of the COVID-19 pandemic on the affordability of healthy diets was through the effect on reduced incomes of the poor rather than through prices. Government relief measures should target low-income households to give them the means to purchase healthy food items.