E-Commerce and global dietary health: a longitudinal analysis of food availability and imports pathways across 64 countries (2008-2022).

Background: Improving dietary health has become a key objective in public health policies worldwide. Concurrently, rapid technological advancements have profoundly altered food acquisition methods, with the widespread adoption of the internet shifting food commerce from offline to online platforms. This study aims to empirically examine the impact of e-commerce on residents' dietary health.

Methods: Utilising unbalanced panel data from 64 countries between 2008 and 2022, this study employs a two-way fixed-effects model to empirically analyse the effects of e-commerce on dietary health. Mediation analysis is conducted to examine the underlying mechanisms, specifically food availability and food imports. Heterogeneity analysis is conducted to investigate the heterogeneity of these effects with different economic development levels.

Results: E-commerce positively promotes dietary health among residents. Regarding specific dimensions of dietary health, the promotion effects of e-commerce on the Healthy Food Diet Index (HFD) and the Balanced Index of Food Consumption Structure (f_coi) are stronger than on the Balanced Index of Nutritional Structure (n_coi). Mechanism tests indicate that food availability acts as a partial mediating factor in the relationship between e-commerce and dietary health, while food imports mediate the relationship between e-commerce and two dietary health dimensions (HFD and f_coi) with indirect effect of 5.0% and 7.3% respectively. Heterogeneity analysis reveals that the positive impact of e-commerce on HFD and f_coi weakens progressively with rising levels of economic development.

Conclusions: It is recommended that efforts should be made to strengthen supporting infrastructure such as cold chain logistics to effectively promote the positive impact of e-commerce on dietary health, especially in low-income countries. Concurrently, vigilant monitoring is required to mitigate the exacerbating effects of food imports on dietary health. The higher marginal benefit of e-commerce development on dietary health in low-income countries effectively narrows the dietary health gap with developed nations, thereby advancing global health equity.