Household Refrigerators as the “Last Mile” of the Cold Chain: Impacts on Dietary Quality in Rural China

ABSTRACT

Household refrigerators extend the last mile of the cold chain into the home, but their implications for dietary quality in developing food systems remain unclear. Using household panel data from China's Fixed Observation Rural Survey for 2003–2018, we estimate the effect of refrigerator ownership on rural dietary quality along three dimensions: food‐group structure, macronutrient energy shares, and dietary balance, by combining household two‐way fixed effects with instrumental variables based on the Home Appliances to the Countryside subsidy, event‐study diagnostics, and heterogeneity‐robust difference‐in‐differences estimators. The results show that, on average, refrigerator ownership reduces dependence on cereals and increases consumption of selected under‐consumed, nutrient‐dense foods, including fruit, eggs, aquatic products, and soybeans. These changes reduce deficiency‐side dietary imbalance. However, refrigerator ownership also increases meat and cooking oil consumption, lowers the carbohydrate energy share, and raises the fat energy share, with little change in total energy intake or the protein energy share. The reduction in under‐consumption is therefore offset by greater excess‐side imbalance, leaving overall dietary balance statistically unchanged. Event‐study estimates further show that the fruit and meat responses are concentrated in the first 2 post‐adoption years and then attenuate, whereas the cereal reduction and the macronutrient shift from carbohydrates toward fat are more persistent. The qualitative pattern is robust to checks for pre‐trends, staggered adoption, income‐related dietary upgrading, and food‐away‐from‐home substitution. Heterogeneity analyses show that nutritional returns depend on health education, purchasing power, and regional food culture. Household refrigeration is thus an enabling technology for dietary upgrading, but not a stand‐alone nutrition policy. Cold‐chain and appliance‐promotion policies should be paired with nutrition education, portion guidance, and measures that improve affordable access to healthier perishables.