Urbanisation, dietary change and socio-cultural drivers of nutritional behaviours in Indonesia : a mixed-methods analysis

The convergence of a changing burden towards increased rates of diet-related non-communicable diseases (NCDs) and of growing rates of urbanisation—considered a key upstream factor in shiftingdiets towards patterns conducive to NCDs—has drawn attention to low and middle-income countries (LMICs) as the epicentre of current global public health challenges. Using the case of Indonesia, a country that has undergone major shifts in terms of socio-economic and health indicators over the past decades, this thesis problematises the assumed linearity of food systems and dietary change in LMICs, and the role of urbanisation in these processes. It examines whether there is evidence of an alternative narrative of change, which can account for the heterogeneity existing in food systems and cultures between and within LMICs and in their urban food environments. The first part of the thesis studies the relationship between urbanisation and diets through the analysis of large-scale quantitative longitudinal data available for Indonesia. Findings from this portion of the thesis suggest that some components of the traditional diet are resilient to the socio-economic shifts associated with increased urbanisation; and that varying urbanisation levels at more localised scales have different effects on diets. In the second part of the thesis, these findings are triangulated with qualitative insights from fieldwork in Yogyakarta, Indonesia. Results from this narrower geographical perspective show that urban food environments and the foodways of local residents are resilient to processes of food systems change. Qualitative findings also highlight the key role of individual agency and of contextual socio-economic and cultural factors as moderators of nutritional behaviours. The thesis concludes by highlighting that processes of nutrition transition are highly complex, and that predictions on their outcomes in terms of (nutritional) health are prone to overgeneralisations that can overshadow localised change dynamics. Findings from my research show that, while some of the predicted shifts in diets have occurred in Indonesia, there is evidence that many others have been less dramatic than expected, or have not materialised at all. Rather, my findings suggest the persistence of an enduring negotiation between the desire to retain local traditional diets and the (physical and economic) possibility to do so, amidst rising social and economic disruption. In turn, this highlights the need to account for contextual and localised nuances in the analysis of dietary change processes across LMICs, to better inform interventions that can effectively improve population health.