Monitoring the price and affordability of foods and diets globally

Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between ‘less healthy’ and ‘healthy’ foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. ‘Minimal’ data collection will assess the differential price of ‘healthy’ and ‘less healthy’ foods; ‘expanded’ monitoring will assess the differential price of ‘healthy’ and ‘less healthy’ diets; and the ‘optimal’ approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of ‘healthy’ and ‘less healthy’ foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation.

The increasing cost of healthy food

OBJECTIVE: To assess changes in the cost and availability of a standard basket of healthy food items (the Healthy Food Access Basket [HFAB]) in Queensland. METHODS: Analysis of five cross-sectional surveys (1998, 2000, 2001, 2004 and 2006) describes changes over time. Eighty-nine stores in five remoteness categories were surveyed during May 2006. For the first time a sampling framework based on randomisation of towns throughout the state was applied and the survey was conducted by Queensland Treasury. RESULTS: Compared with the costs in major cities, in 2006 the mean cost of the HFAB was $107.81 (24.2%) higher in very remote stores in Queensland, but $145.57 (32.6%) higher in stores more than 2,000 kilometres from Brisbane. Over six years the cost of the HFAB has increased by around 50% ($148.87) across Queensland and, where data was available, by more than the cost of less healthy alternatives. The Consumer Price Index for food in Brisbane increased by 32.5% over the same period. CONCLUSIONS AND IMPLICATIONS: Australians, no matter where they live, need access to affordable, healthy food. Issues of food security in the face of rising food costs are of concern particularly in the current global economic downturn. There is an urgent need to nationally monitor, but also sustainably address the factors affecting the price of healthy foods, particularly for vulnerable groups who suffer a disproportionate burden of poor health.

Creating healthy food environments in N.S.W.: A knowledge and evidence synthesis to inform advocacy and action: Food pricing

Reviews and synthesizes evidence to produce evidence-based recommendations on policy actions to improve food pricing for NSW Health

Priority research questions for the UK food system

The rise of food security up international political, societal and academic agendas has led to increasing interest in novel means of improving primary food production and reducing waste. There are however, also many 'post-farm gate' activities that are critical to food security, including processing, packaging, distributing, retailing, cooking and consuming. These activities all affect a range of important food security elements, notably availability, affordability and other aspects of access, nutrition and safety. Addressing the challenge of universal food security, in the context of a number of other policy goals (e.g. social, economic and environmental sustainability), is of keen interest to a range of UK stakeholders but requires an up-to-date evidence base and continuous innovation. An exercise was therefore conducted, under the auspices of the UK Global Food Security Programme, to identify priority research questions with a focus on the UK food system (though the outcomes may be broadly applicable to other developed nations). Emphasis was placed on incorporating a wide range of perspectives ('world views') from different stakeholder groups: policy, private sector, non-governmental organisations, advocacy groups and academia. A total of 456 individuals submitted 820 questions from which 100 were selected by a process of online voting and a three-stage workshop voting exercise. These 100 final questions were sorted into 10 themes and the 'top' question for each theme identified by a further voting exercise. This step also allowed four different stakeholder groups to select the top 7-8 questions from their perspectives. Results of these voting exercises are presented. It is clear from the wide range of questions prioritised in this exercise that the different stakeholder groups identified specific research needs on a range of post-farm gate activities and food security outcomes. Evidence needs related to food affordability, nutrition and food safety (all key elements of food security) featured highly in the exercise. While there were some questions relating to climate impacts on production, other important topics for food security (e.g. trade, transport, preference and cultural needs) were not viewed as strongly by the participants.

Local food security initiatives: systemic limitations in Vancouver, Canada

This paper approaches the topic of urban/community gardening not through the lens of urban theory per se but in light of basic farming realities such as growing season and land availability. Food security comprises availability and affordability. In the context of North American and Western European societies, only food affordability normally merits public discourse. In practice, governments have little or no means to change food affordability, in view of prevailing capitalistic free-market structures. In the current wave of popular exuberance, civic politicians and others have promoted the belief that community gardening could be the pathway to produce affordable food. The formidable obstacles to this pursuit include the availability of (low-cost) land within the highly-densified city limit, insufficient ambient temperature and water supply during the growing season and the contemporary structure of society. Overcoming these fundamental hurdles carries significant negative environmental and economic consequences.

Priority research questions for the UK food system

The rise of food security up international political, societal and academic agendas has led to increasing interest in novel means of improving primary food production and reducing waste. There are however, also many ‘post-farm gate’ activities that are critical to food security, including processing, packaging, distributing, retailing, cooking and consuming. These activities all affect a range of important food security elements, notably availability, affordability and other aspects of access, nutrition and safety. Addressing the challenge of universal food security, in the context of a number of other policy goals (e.g. social, economic and environmental sustainability), is of keen interest to a range of UK stakeholders but requires an up-to-date evidence base and continuous innovation. An exercise was therefore conducted, under the auspices of the UK Global Food Security Programme, to identify priority research questions with a focus on the UK food system (though the outcomes may be broadly applicable to other developed nations). Emphasis was placed on incorporating a wide range of perspectives (‘world views’) from different stakeholder groups: policy, private sector, non-governmental organisations, advocacy groups and academia. A total of 456 individuals submitted 820 questions from which 100 were selected by a process of online voting and a three-stage workshop voting exercise. These 100 final questions were sorted into 10 themes and the ‘top’ question for each theme identified by a further voting exercise. This step also allowed four different stakeholder groups to select the top 7–8 questions from their perspectives. Results of these voting exercises are presented. It is clear from the wide range of questions prioritised in this exercise that the different stakeholder groups identified specific research needs on a range of post-farm gate activities and food security outcomes. Evidence needs related to food affordability, nutrition and food safety (all key elements of food security) featured highly in the exercise. While there were some questions relating to climate impacts on production, other important topics for food security (e.g. trade, transport, preference and cultural needs) were not viewed as strongly by the participants.

Developing standardized methods to assess cost of healthy and unhealthy (current) diets in Australia

Unhealthy diets contribute at least 14% to Australia's disease burden and are driven by ‘obesogenic’ food environments. Compliance with dietary recommendations is particularly poor amongst disadvantaged populations including low socioeconomic groups, those living in rural/remote areas and Aboriginal and Torres Strait Islanders. The perception that healthy foods are expensive is a key barrier to healthy choices and a major determinant of diet-related health inequities. Available state/regional/local data (limited and non-comparable) suggests that, despite basic healthy foods not incurring GST, the cost of healthy food is higher and has increased more rapidly than unhealthy food over the last 15 years in Australia. However, there were no nationally standardised tools or protocols to benchmark, compare or monitor food prices and affordability in Australia. Globally, we are leading work to develop and test approaches to assess the price differential of healthy and less-healthy (current) diets under the food price module of the International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS). This presentation describes contextualization of the INFORMAS approach to develop standardised Australian tools, survey protocols and data collection and analysis systems. The ‘healthy diet basket’ was based on the Australian Foundation Diet, 1 The ‘current diet basket’ and specific items included in each basket, were based on recent national dietary survey data.2 Data collection methods were piloted. The final tools and protocols were then applied to measure the price and affordability of healthy and less healthy (current) diets of different household groups in diverse communities across the nation. We have compared results for different geographical locations/population subgroups in Australia and assessed these against international INFORMAS benchmarks. The results inform the development of policy and practice, including those relevant to mooted changes to the GST base, to promote nutrition and healthy weight and prevent chronic disease in Australia.

L’accès aux ressources alimentaires : facteurs prédicteurs de l’insécurité alimentaire sévère parmi les ménages bénéficiers des programmes communautaires en sécurité alimentaire à Montréal

Objectif : Examiner la relation entre l’accès aux ressources alimentaires et le degré de l’insécurité alimentaire du ménage parmi les nouveaux utilisateurs des organismes communautaires d’intervention en sécurité alimentaire de Montréal. Méthode : Étude observationnelle transversale. Elle consiste en une analyse secondaire de données (n=785) qui proviennent du premier temps de mesure de l’enquête sur les effets des interventions en sécurité alimentaire à Montréal menée entre 2011 et 2012. La variable dépendante a été l’insécurité alimentaire. Les variables indépendantes ont été le mode de transport utilisé pour transporter les aliments, l’emplacement de l’épicerie la plus fréquentée par le participant, la distance entre l’organisme communautaire fréquenté par le participant et son domicile, la proximité de l’épicerie la plus fréquentée, la satisfaction quant à l’acceptabilité et le caractère abordable des aliments dans l’épicerie la plus fréquentée, et les difficultés d’accès aux aliments. Des régressions logistiques furent effectuées afin d’évaluer la relation entre les variables indépendantes et le degré de l’insécurité alimentaire, en utilisant l’insécurité sévère comme catégorie de référence. Résultats : Nos données suggèrent que la sévérité de l’insécurité alimentaire est associée à la difficulté d’accès aux aliments à cause de la cherté des aliments (pour la sécurité alimentaire, OR=0.13; CI : 0.07-0.25 et pour l’insécurité alimentaire modérée, OR=0.42; CI : 0.28-0.63), au fait de faire l’épicerie à l’extérieur du quartier ou de faire rarement l’épicerie (pour l’insécurité alimentaire modérée, OR=0.50, CI : 0.30-0.84), au fait d’avoir accès au transport collectif (pour l’insécurité alimentaire modérée, OR=1.73; CI : 1.09-2.73), au fait de résider à une distance moyenne (soit entre 1000 et 2000 mètres) d’un organisme communautaire en sécurité alimentaire (pour l’insécurité alimentaire modérée, OR=1.83; CI : 1.14-2.92), et à la difficulté d’accès aux aliments à cause de contraintes de transport (pour la sécurité alimentaire, OR=0.18, CI : 0.06-0.52). Conclusion : L’accès aux ressources alimentaires est associé au degré de l’insécurité alimentaire des nouveaux ménages participant aux interventions en sécurité alimentaire à Montréal.

L’accès aux ressources alimentaires : facteurs prédicteurs de l’insécurité alimentaire sévère parmi les ménages bénéficiers des programmes communautaires en sécurité alimentaire à Montréal

Objectif : Examiner la relation entre l’accès aux ressources alimentaires et le degré de l’insécurité alimentaire du ménage parmi les nouveaux utilisateurs des organismes communautaires d’intervention en sécurité alimentaire de Montréal. Méthode : Étude observationnelle transversale. Elle consiste en une analyse secondaire de données (n=785) qui proviennent du premier temps de mesure de l’enquête sur les effets des interventions en sécurité alimentaire à Montréal menée entre 2011 et 2012. La variable dépendante a été l’insécurité alimentaire. Les variables indépendantes ont été le mode de transport utilisé pour transporter les aliments, l’emplacement de l’épicerie la plus fréquentée par le participant, la distance entre l’organisme communautaire fréquenté par le participant et son domicile, la proximité de l’épicerie la plus fréquentée, la satisfaction quant à l’acceptabilité et le caractère abordable des aliments dans l’épicerie la plus fréquentée, et les difficultés d’accès aux aliments. Des régressions logistiques furent effectuées afin d’évaluer la relation entre les variables indépendantes et le degré de l’insécurité alimentaire, en utilisant l’insécurité sévère comme catégorie de référence. Résultats : Nos données suggèrent que la sévérité de l’insécurité alimentaire est associée à la difficulté d’accès aux aliments à cause de la cherté des aliments (pour la sécurité alimentaire, OR=0.13; CI : 0.07-0.25 et pour l’insécurité alimentaire modérée, OR=0.42; CI : 0.28-0.63), au fait de faire l’épicerie à l’extérieur du quartier ou de faire rarement l’épicerie (pour l’insécurité alimentaire modérée, OR=0.50, CI : 0.30-0.84), au fait d’avoir accès au transport collectif (pour l’insécurité alimentaire modérée, OR=1.73; CI : 1.09-2.73), au fait de résider à une distance moyenne (soit entre 1000 et 2000 mètres) d’un organisme communautaire en sécurité alimentaire (pour l’insécurité alimentaire modérée, OR=1.83; CI : 1.14-2.92), et à la difficulté d’accès aux aliments à cause de contraintes de transport (pour la sécurité alimentaire, OR=0.18, CI : 0.06-0.52). Conclusion : L’accès aux ressources alimentaires est associé au degré de l’insécurité alimentaire des nouveaux ménages participant aux interventions en sécurité alimentaire à Montréal.

Food price and affordability update

This presentation outlines recent achievements in development of tools, protocols and methods to monitoring and benchmark food prices and affordability globally under International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support(INFORMAS)

Symposium: Food pricing and affordability of ‘healthy’ versus ‘less healthy’ diets: An international approach to monitoring and surveillance

Symposium co-ordinated by The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) Purpose Global monitoring of the price and affordability of foods, meals and diets is urgently needed. There are major methodological challenges in developing robust, cost-effective, standardized, and policy relevant tools, pertinent to nutrition, obesity, and diet-related non-communicable diseases and their inequalities. There is increasing pressure to take into account environmental sustainability. Changes in price differentials and affordability need to be comparable between and within countries and over time. Robust tools could provide baseline data for monitoring and evaluating structural, economic and social policies at the country/regional and household levels. INFORMAS offers one framework for consideration.

A multilevel study of area socio-economic status and food purchasing behaviour

Objective: This study examined the association between area socioeconomic status (SES) and food purchasing behaviour.----- Setting: Melbourne city, Australia, 2003.----- Participants: Residents of 2,564 households located in 50 small areas.----- Design: Data were collected by mail survey (64.2% response rate). Area SES was indicated by the proportion of households in each area earning less than Aus$400 per week, and individual-level socioeconomic position was measured using education, occupation, and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socioeconomic factors.----- Results: Residents of low SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt, and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety.----- Conclusions In Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility, and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.

A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention

Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first (‘minimal’) step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second (‘expanded’) step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third (‘optimal’) step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.

Improving food supply

Improving the availability, accessibility and affordability of healthy food equitably is fundamental to improving nutrition and health. While theoretical models abound, in real world complex systems rarely are there opportunities to address leverage points systematically to improve food supply. This presentation describes efforts over the last 30 years to do just that by remote Australian Aboriginal communities, where a single community store is usually the major dietary source. Areas addressed include store governance and infrastructure, wholesale supply, transport and pricing policies including cross-subsidization. However, while there have been dramatic improvements in the availability, quality and price of fruit, vegetables and most other healthy foods over this time, the proportion of communities' energy intake from energy-dense nutrient-poor foods and drinks has increased. One cause may be the disproportionate increase in supply of unhealthy choices in terms of variety and shelf-space, consistent with changes in the food supply in broader Australia. The impact of changing social and environmental factors, food preferences and price elasticity will also be explored briefly. Clearly much more needs to be done to reduce the high prevalence of diet-related chronic disease in some vulnerable groups. In particular, efforts to continually improve the availability and affordability of healthy food also need to address the predominance of unhealthy choices in the food supply.

Measuring cost and affordability of healthy and less healthy diet globally

The INFORMAS food prices module proposes a step-wise framework to measure the cost and affordability of population diets. The price differential and the tax component of healthy and less healthy foods, food groups, meals and diets will be benchmarked and monitored over time. Results can be used to model or assess the impact of fiscal policies, such as ‘fat taxes’ or subsidies. Key methodological challenges include: defining healthy and less healthy foods, meals, diets and commonly consumed items; including costs of alcohol, takeaways, convenience foods and time; selecting the price metric; sampling frameworks; and standardizing collection and analysis protocols. The minimal approach uses three complementary methods to measure the price differential between pairs of healthy and less healthy foods. Specific challenges include choosing policy relevant pairs and defining an anchor for the lists. The expanded approach measures the cost of a healthy diet compared to the current (less healthy) diet for a reference household. It requires dietary principles to guide the development of the healthy diet pricing instrument and sufficient information about the population’s current intake to inform the current (less healthy) diet tool. The optimal approach includes measures of affordability and requires a standardised measure of household income that can be used for different countries. The feasibility of implementing the protocol in different countries is being tested in New Zealand, Australia and Fiji. The impact of different decision points to address challenges will be investigated in a systematic manner. We will present early insights and results from this work.