Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globally

INFORMAS Symposium 2: Benchmarking Food Environments: Key Challenges and Future Directions 

ICDAM9 September 2015Amanda Lee, Professor, School of Public Health and Social Work & School of Exercise and Nutrition Science, QUTSally Mackay, PhD Candidate, Faculty of Medical and Health Sciences, The University of Auckland

Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globally

Outline• Introduction and INFORMAS Step‐wise Framework to monitor the price and 

affordability of foods

• Challenges: • Common to all 3 steps;• Minimal approach;• Expanded and Optimal approaches

• Early results and insights

• Future work and opportunities

• Questions

Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globally

Monitoring food prices: relevant health policy Q?

• Does healthy food really cost more?• What is the price, price differential and affordability of ‘healthy’ and ‘unhealthy’ foods, meals and diets?‐ over time‐ between countries

• Can be used to determine health and economic impacts of different fiscal/health policy scenarios.

CRICOS No. 00213Ja university for the worldreal R

Measuring the cost and affordability of healthy and less healthy diets globally

INFORMAS Stepwise Framework

Source: Lee A et al Monitoring the price and affordability of foods and diets globally, Obesity Reviews, 2013; 14 (Suppl1) 82‐95

Queensland University of Technology

CRICOS No. 00213J

Challenges Common to All Steps• Are data current?• Identifying common foods and

popular brands.• Sampling: location, type of stores,

timing, season. • Product selection: discount price or shelf price?;

generic “home” brand or branded item? availability?

• Taxes, subsidies, price-controlled items?

Queensland University of Technology

CRICOS No. 00213J

Challenges Minimal Approach• Food Groups:

– Defining foods and food groups as healthy and less healthy

– Defining an anchor for food lists

– Including takeaways, alcohol

• Flexibility for differences between countries

• Which price metric?

• Pairs

CRICOS No. 00213Ja university for the worldreal R

PairsHealthy Item Less Healthy ItemWholemeal bread White breadWeet-bix CornflakesCanned fruit salad in juice Canned fruit salad in syrupTrim milk Full-fat milkChicken breast Chicken drumstickDiet soda Regular sodaLow-fat plain yoghurt Full-fat sweetened yoghurtMargarine ButterIs it policy relevant?Similar components, same end purpose, key nutrient difference, readily available.

CRICOS No. 00213Ja university for the worldreal R

MealsMeal CharacteristicsTakeaway Chicken chow mein

Home-assembled convenience meal

Cooked chicken, quick noodles, flavour sachet, frozen stir-fry vegetable

Home-cooked meal Chicken breast,noodles, soy sauce, ginger, garliconion, fresh vegetables

Choose common takeawayMatch home meals for main ingredients and weight

Queensland University of Technology

CRICOS No. 00213J

Cost of TimeCalculating time

– Food preparation– Food purchasing– Clean-up– Transport to takeaway, supermarket– Waiting time takeaways

Which measure of cost?– Median wage– Wage of food preparers

Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globally

Expanded and optimal approaches: more challengesUnhealthy/current diet: ? Access to quality, quantitative, individual food‐based diet survey data ? Use of proxy foods to control number of items in price data survey basket listsHealthy, recommended diet: ? Availability of quality, national, food‐based dietary guidelines? Range of possible menusIncome: Variable definitions and data availability of (median) family/household incomeAlso:? Should there be an allowance for wastage?? Assumptions: eg. minimal home production; food shared equitably in household? Include alcohol, take‐away, convenience and pre‐prepared foods, bottled water? Include externalities such as cost of transport, cooking equipment, utilities..? Complexity  and transferability

Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globally 

Cost of diets and composite food groups, healthy (recommended) and current (unhealthy) diets, 5 household structures, Brisbane 2014

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t ($)

Sugar sweetened beverages

Alcohol

Take‐away foods

Discretionary choices, other*

Unsaturated oils & spreads

Fruit

Vegetables & legumes/beans

Grains (cereals) foods

Milk, yoghurt, cheese &/oralternatives

*All other discretionary choices excluding alcohol, take-away foods and sugar-sweetened beverages

$580  $662

Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globally

Brisbane Pilot: Affordability

_ _ _ _ _ _ _ _ _ _ _ _ _ _  25%

Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globallyBrisbane Pilot: Affordability

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low incomeHH

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low incomeHH

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low incomeHH

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Lowincome HH

Extend GST base Increase GST base to15%

Increase GST base to20%

Present affordability Projected affordability

Percen

tage dispo

sable income spen

t on diet (%

)

Current(unhealthy) diet

Healthy(recommended)diet

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Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globally

Future work• Test all options• Publish and promote pilot results, methodology, protocols• Finalise standardised national baskets in Australia, Fiji and NZ • Develop study resources e.g. i‐pad application for data collection; on‐line 

calculators• Data collection• Work towards harmonised global methodology • Set up national monitoring and reporting frameworks• Benchmark relative price and affordability indices• Set up global monitoring and reporting frameworks• ? Embed CPI (food) and CPI (healthy food) indicators in

national price monitoring systems

Queensland University of Technology

CRICOS No. 00213J

Measuring the cost and affordability of healthy and less healthy diets globally

Questions?Thank youAcknowledgements: 

• The International Network for Food and Obesity/non Communicable disease Research, Monitoring and Action Support (INFORMAS)

• The Australian Prevention Partnership Centre, for funding• University of Auckland: Boyd Swinburn, Stefanie Vandevijvere• QUT: Sarah Kane• Qld Dept. Health: Mathew Dick; Elizabeth Good