Availability,affordability and quality of a healthy food basket in Adelaide,South Australia

Aim: To investigate the cost, affordability, availability and quality of a healthy food basket in high and low household income areas of Adelaide, and to investigate food promotion in supermarkets. Methods: A cross‐sectional survey was undertaken in May 2009 with a sample of 61 supermarkets, 27 greengrocers and 34 butchers in metropolitan Adelaide. Samples were selected based on household income for extreme tertiles across Adelaide. Results: Low‐income families were significantly worse off in comparison with high‐income families (P < 0.05) regarding affordability of the healthy food basket. The data analysis demonstrated that families on welfare payments and low incomes would need to spend 28–34% of their income in order to be able to afford a healthy food basket. However, there was no significant difference in the cost, availability, and quality of the healthy food basket and food promotions between high and low household income areas. Conclusion: The present study examined the cost, affordability, availability and quality of the healthy food basket, as well as an assessment of food promotions in supermarkets, finding no difference between high and low household income areas. The study provides valuable information to assist in a deeper understanding of food security in Adelaide. It is recommended that a longitudinal study would assist in establishing a reliable healthy food basket monitoring system that could lead to more robust policy outcomes.     

Trends in affordability of the Illawarra Healthy Food Basket 2000–2007

Aims:  The Illawarra Healthy Food Basket was developed as one measure to monitor the affordability of healthy eating in Australia. It consists of 57 items selected to meet the nutritional requirements of a reference family of five. The basket was first costed in the Illawarra region of Australia in 2000 and again in 2001 and 2003. The present study aimed to repeat the costing of the basket in 2005 and 2007 and to assess the trends in affordability since 2000.
Methods:  Costing was carried out in the same five suburbs as previous surveys, using a large supermarket, greengrocer and butcher from each. Comparison data included: welfare entitlements obtained from Centrelink, average weekly earnings and the consumer price index for food.
Main outcome measures:  The average weekly cost of the Illawarra Healthy Food Basket in 2005 and 2007, and trends in the costs compared with changes in average weekly earning and welfare benefits for the reference family.
Results:  The total cost of the Illawarra Healthy Food Basket in 2007 was $242.49, an increase of 20.4% since 2000, with the greatest increases in the prices of vegetables (55.7%) and fruit (46.7%). Fruits, vegetables and meat were cheaper at independent grocers and butchers than in supermarkets. The percentage of average weekly earning or welfare payments required to purchase the Illawarra Healthy Food Basket remained stable at slightly below 30%.
Conclusion:  These results indicate that the affordability of healthy eating has remained relatively constant from 2000 to 2007, but the significant increases in fruit and vegetable prices might be making healthy food choices more difficult.     

Is a Healthy Diet Affordable and Accessible in the City of Yarra,Victoria-Australia? An Analysis of Cost Disparity and Nutritional Choices

This study aimed to examine cost disparity and nutritional choices within the City of Yarra (Yarra), targeting three suburbs that have low- and high-rise estates: Richmond, Fitzroy, and Collingwood. The healthy food basket (HFB) was modeled on the Queensland Healthy Food Access Basket for a six-person family for a fortnight and was constructed to include food items that are common to ethnic groups living in Yarra. The HFB food item costs were sampled across 29 food outlets in Yarra. The average cost of HFB per fortnight for a family of six was significantly lower in Richmond (Mean?=?$419.26) than in Collingwood (Mean?=?$519.28) and in Fitzroy (Mean?=?$433.98). While costs for cereal groups, dairy, meats and alternatives, and non-core were comparable across the suburbs, significant differences were noticed for fruit, legumes and vegetables. Geographic location alone explained 54% of the variance in HFB price (F_2,26?=?15.23, p < 0.001) and 32.7% in the variance of fruit, vegetable and legumes (F_2,26?=?7.72, p < 0.001). The effect of geographic location remained consistent after controlling for the type of food outlets. The type of food outlets had a non-significant effect on the variance of prices. Richmond had a greater number variety of fruit, vegetables, and legumes (F_{2, 26}?=?5.7, p < 0.01) and an overall lower number of missing items (F_{2, 26}?=?3.9, p < 0.05) than Collingwood and Fitzroy. The diversity of food available in the three suburbs was more likely to reflect the Vietnamese, Chinese and East-Timorese shopping pattern than the rest of other ethnic groups. These findings indicate that there is inequality in food access in terms of cost and availability in Yarra and such inequality is function of location and not the type of food outlets. The differential economic access to a HFB in Yarra could be addressed using a multi-faceted approach, including implementing policies that encourage diversity of food outlets and putting in place incentive-based policies to encourage the consumption of fruit, vegetables and legumes, and taking actions toward promoting supply of ethnic foods.     

Monitoring the affordability of healthy eating: a case study of 10 years of the Illawarra Healthy Food Basket

Healthy food baskets have been used around the world for a variety of purposes, including: examining the difference in cost between healthy and unhealthy food; mapping the availability of healthy foods in different locations; calculating the minimum cost of an adequate diet for social policy planning; developing educational material on low cost eating and examining trends on food costs over time. In Australia, the Illawarra Healthy Food Basket was developed in 2000 to monitor trends in the affordability of healthy food compared to average weekly wages and social welfare benefits for the unemployed. It consists of 57 items selected to meet the nutritional requirements of a reference family of five. Bi-annual costing from 2000-2009 has shown that the basket costs have increased by 38.4% in the 10-year period, but that affordability has remained relatively constant at around 30% of average household incomes.     

Affordability of Heathy,Equitable and More Sustainable Diets in Low-Income Households in Brisbane before and during the COVID-19 Pandemic

The COVID-19 pandemic has increased food insecurity worldwide, yet there has been limited assessment of shifts in the cost and affordability of healthy, equitable and sustainable diets. This study explores the impact of the COVID-19 pandemic and income supplements provided by the Australian government on diet cost and affordability for low-income households in an Australian urban area. The Healthy Diets ASAP method protocol was applied to assess the cost and cost differential of current and recommended diets before (in 2019) and during the COVID-19 pandemic (late 2020) for households with a minimum-wage and welfare-only disposable household income, by area of socioeconomic disadvantage, in Greater Brisbane, Queensland, Australia. Data were collected between August and October, 2020, from 78 food outlets and compared with data collected in the same locations between May and October, 2019, in an earlier study. The price of most healthy food groups increased significantly during the pandemic—with the exception of vegetables and legumes, which decreased. Conversely, the price of discretionary foods and drinks did not increase during the pandemic. The cost of the current and recommended diets significantly increased throughout this period, but the latter continued to be less expensive than the former. Due to income supplements provided between May and September 2020, the affordability of the recommended diet improved greatly, by 27% and 42%, for households with minimum-wage and welfare-only disposable household income, respectively. This improvement in the affordability of the recommended diet highlights the need to permanently increase welfare support for low-income families to ensure food security.     

A longitudinal study of the cost of food in Victoria influenced by geography and nutritional quality

Objective : To monitor the cost and affordability of a nutritious diet and to assess the influence of distance from the capital city and socioeconomic status on the cost of nutritious food in Victoria. Methods : Twenty‐six of Victoria's 79 local government areas (33%) were randomly chosen for inclusion in the study. A random sample of stores was selected for inclusion from each local government area. The cost of the 44 ‘healthy’ and 10 ‘discretionary’ food and drinks in the healthy food basket for a family of four for a fortnight was collected during the winter and summer of 2012, 2013 and 2014. Results : The mean cost of the basket increased from $424.06 ± 38.22 in winter 2012 to $451.19 ± 33.83 in summer 2014 (p<0.001), representing about 31% of government benefit household income. Fruit and vegetables prices were the most varied over time. Distance of the store from state capital city centre predicted difference in food cost. Conclusions : These findings show that a healthy diet may be unaffordable for some Victorians. Implications : The cost of food is a key factor influencing intake. Public health strategies may need to consider strategies to make healthy food more affordable for some.     

A healthy diet consistent with Australian health recommendations is too expensive for welfare‐dependent families

Objective: Examine the cost of healthy food habits for welfare‐dependent families in Australia. Method: A seven‐day meal plan was developed, based on Australian public health recommendations, for two typical welfare‐dependent families: a couple‐family (two adults, two children) and a one‐parent family (one adult, two children). The cost of the meal plan was calculated using market brand and generic brand grocery items, and total cost compared to income. Results: In Australia, the cost of healthy food habits uses about 40% of the disposable income of welfare‐dependent families. Families earning an average income would spend only 20% of their disposable income to buy the same healthy food. Substituting generic brands for market brands reduced the weekly food cost by about 13%. This is one of few economic models to include generic brands. Conclusion: Compared with average‐income Australian families, healthy food habits are a fiscal challenge to welfare‐dependent families. Implications: These results provide a benchmark for economic and social policy analysis, and the influence disposable income has on prioritising healthy food habits.     

Socioeconomic differences in the cost,availability and quality of healthy food in Sydney

Objective: To compare the cost of a basket of staple foods, together with the availability and quality of fresh fruit and vegetables, by supermarket store type in high and low socioeconomic suburbs of Sydney. Methods: A food basket survey was undertaken in 100 supermarkets in the 20 highest and 20 lowest socioeconomic suburbs of Sydney. We assessed the cost of 46 foods, the range of 30 fresh fruit and vegetables and the quality of ten fresh fruit and vegetables. Two major supermarket retailers, a discount supermarket chain and independent grocery stores were surveyed. Results: The food basket was significantly cheaper in low compared to high socioeconomic suburbs ($177 vs $189, p<0.01). Discount supermarkets were at least 30% cheaper than other supermarket stores. There were fewer varieties and poorer quality fruit and vegetables in stores in low socioeconomic suburbs. Conclusions: Food basket prices and the availability and quality of fruit and vegetables varied significantly by store type and socioeconomic status of suburb. Implications for public health: A nationwide food and nutrition surveillance system is required to inform public health policy and practice initiatives. In addition to the food retail environment, these initiatives must address the underlying contributors to inequity and food insecurity for disadvantaged groups.     

The cost of a healthy and sustainable diet – who can afford it?

Objective: Climate change is affecting the ability of food systems to provide sufficient nutritious and affordable foods at all times. Healthy and sustainable (H&S) food choices are important contributions to health and climate change policy efforts. This paper presents empirical data on the affordability of a food basket that incorporates principles of health and sustainability across different food sub‐systems, socioeconomic neighbourhoods and household income levels in Greater Western Sydney, Australia. Methods: A basket survey was used to investigate the cost of both a typical basket of food and a hypothetical H&S basket. The price of foods in the two baskets was recorded in five neighbourhoods, and the affordability of the baskets was determined across household income quintiles. Results: The cost of the H&S basket was more than the typical basket in all five socioeconomic neighbourhoods, with most disadvantaged neighbourhood spending proportionately more (30%) to buy the H&S basket. Within household income levels, the greatest inequity was found in the middle income neighbourhood, showing that households in the lowest income quintile would have to spend up to 48% of their weekly income to buy the H&S basket, while households in the highest income quintile would have to spend significantly less of their weekly income (9%). Conclusion: The most disadvantaged groups in the region, both at the neighbourhood and household level, experience the greatest inequality in affordability of the H&S diet. Implications: The results highlight the current inequity in food choice in the region and the underlying social issues of cost and affordability of H&S foods.     

Socioeconomic correlates of mortality differentials by local government area in rural northern New South Wales, 1981-1995

OBJECTIVE: Many studies have examined the correlation between socioeconomic status (SES) and mortality in Australia, but little is known about the correlation in rural areas and most studies have not explored the trends in SES differentials in mortality. This ecological study examines this correlation and explores the impact of the national strategies to reduce SES differentials in mortality in a rural area. METHODS: Mortality data for residents in the New England Health Area, New South Wales (NSW), 1981 to 1995, were analysed. Twenty Local Government Areas (LGAs) in New England were ranked and aggregated into 4 groups according to a composite SES indicator from the 1996 census, and age/sex adjusted mortality rates were calculated for each group and compared. Poisson regression models were used to assess the linear trends in mortality for 1981-95. RESULTS: A strong relationship between working age adult mortality and SES was found for both sexes. The rates for the most disadvantaged LGAs were significantly higher than the least disadvantaged LGAs for both sexes. The mortality rate was consistently higher for the most disadvantaged LGAs than the least disadvantaged LGAs. CONCLUSION AND IMPLICATION: Although there has been an overall decline in death for all 4 groups of LGAs, the gap between the most disadvantaged and the least disadvantaged groups has widened over the last 15 years. This widening gap in death rates suggests that the strategies implemented as part of the Health for All initiative to reduce inequalities in mortality differentials have not been effective in this rural area.     

Accessibility of Nutritious African Foods for an Adequate Diet in Bulawayo,Zimbabwe

Despite being an agriculturally productive country, Zimbabwe has a high prevalence of undernutrition. Our purpose was to study the implications of food pricing policies on the accessibility of nutritious foods purchased through the formal market economy to the urban black (indigenous) population of Bulawayo, Zimbabwe. A validated food basket was created to calculate the cost of meeting the nutritional needs of a typical low-income urban family. Food prices were surveyed during July (winter) 1995 in three regions of Bulawayo. The mean monthly cost of the food basket in the high-density suburbs (low-income region) was Z$l,181.12 (± 74.60).This is 7% higher than in the city center (predominantly nonresidential; mean basket cost = $1,101.65 ± 52.83) and 10% higher than in the low-density suburbs (higher income region; mean basket cost = $1,069.46 ± 44.37). Comparison of monthly food basket costs in the high-density suburbs to government-stipulated minimum wages typical of employed low-income families revealed food costs 2.3 to 4.88 times the total monthly salary for one worker.The household food insecurity experienced by the low-income urban black population is discussed in relation to government policies adopted in response to structural adjustment programs.     

The cost-effectiveness of teleradiology at the Women's and Children's Hospital in Adelaide

The cost-effectiveness of teleradiology was examined in a trial conducted at the Women's and Children's Hospital (WCH) in Adelaide, from February 1998 to February 1999. The trial showed that, with the large distances between remote hospitals and metropolitan hospitals, teleradiology, relative to the transfer of remote patients, could be highly cost-effective, but that a new form of cost justification is required for teleradiology for tertiary hospitals providing second opinions in special cases. A series of compelling case studies proved the economic and social value of teleradiology at the WCH.     

Spatial and socioeconomic inequities in liveability in Australia’s 21 largest cities: Does city size matter?

Spatial and area-level socioeconomic variation in urban liveability (access to social infrastructure, public transport, open space, healthy food choices, local employment, street connectivity, dwelling density, and housing affordability) was examined and mapped across 39,967 residential statistical areas in Australia's metropolitan (n = 7) and largest regional cities (n = 14). Urban liveability varied spatially, with inner-city areas more liveable than outer suburbs. Disadvantaged areas in larger metropolitan cities were less liveable than advantaged areas, but this pattern was reversed in smaller cities. Local data could inform policies to redress inequities, including those designed to avoid disadvantage being suburbanised as cities grow and gentrify.     

Industry, air quality, cigarette smoke and rates of respiratory illness in Port Adelaide

OBJECTIVES: To examine the prevalence of self-reported asthma, bronchitis/emphysema, wheezing, night cough and smoking in Port Adelaide; to explore the relationship of the disorders to the presence of industry, tobacco smoke, indoor appliances and air quality. METHODS: Prevalence data from a 1995 survey of Port Adelaide residents were compared with data from the 1995 National Health Survey and the 1995 South Australian Health Omnibus Survey. These data were then compared across three geographic areas in Port Adelaide, one being highly industrialised. Their relation to tobacco smoke and the presence of unflued gas appliances were examined. Finally, outdoor gaseous air pollutants were examined across the three areas. RESULTS: Males in Port Adelaide had higher rates of asthma and bronchitis/emphysema than nationally. Asthma was significantly higher for children aged 5-14 years and for adults aged 25-44 years. Bronchitis/emphysema was significantly higher for males aged 25-64. The highly industrial area had a higher rate of asthma (OR 1.85, 95% CI 1.07-3.22) in males that appeared unrelated to smoking or ambient gaseous pollutants. Smoking in Port Adelaide was significantly higher than in the general population, and was significantly associated with wheeze, night cough and bronchitis/emphysema. The presence of unflued gas heaters at home was significantly associated with asthma prevalence in males (OR 3.27, 95% CI 1.40-7.64). CONCLUSIONS: Respiratory disease appeared to be independently related to an area of high industry, smoking and presence of unflued gas appliances in Port Adelaide.     

Cost and Affordability of Healthy,Equitable and Sustainable Diets in Low Socioeconomic Groups in Australia

Few Australians consume a healthy, equitable and more sustainable diet consistent with the Australian Dietary Guidelines (ADGs). Low socioeconomic groups (SEGs) suffer particularly poor diet-related health problems. However, granular information on dietary intakes and affordability of recommended diets was lacking for low SEGs. The Healthy Diets Australian Standardised Affordability and Pricing protocol was modified for low SEGs to align with relevant dietary intakes reported in the National Nutrition Survey 2011–2012(which included less healthy and more discretionary options than the broader population), household structures, food purchasing habits, and incomes. Cost and affordability of habitual and recommended diets of low SEGs were calculated using prices of ‘standard brands’ and ‘cheapest options’. With ‘standard brands’, recommended diets cost less than habitual diets, but were unaffordable for low SEGs. With ‘cheapest options’, both diets were more affordable, but recommended diets cost more than habitual diets for some low SEGs, potentially contributing to perceptions that healthy food is unaffordable. The study confirms the need for an equity lens to better target dietary guidelines for low SEGs. It also highlights urgent policy action is needed to help improve affordability of recommended diets.     

Chronic obstructive pulmonary disease hospitalisations and mortality in Victoria: analysis of variations by socioeconomic status

Objective: This paper analysed chronic obstructive pulmonary disease (COPD) hospitalisations, unplanned readmissions and deaths in Victoria to identify associations with socioeconomic status (SES). Methods: The data was taken from the Victorian Admitted Episodes Dataset, the Victorian Health Information Surveillance System, the Victorian Burden of Disease Study and the Australian Bureau of Statistics’ Index of Relative Socioeconomic Disadvantage. Results: COPD separations have a greater variation by SES than all separations. The average age‐standardised separation rate (10.43) for the top percentile Local Government Areas (LGA) was 5.8 times that of the bottom percentile LGAs (1.80). The top percentile group was the lowest SES group (effect size = 0.93). There were significant negative correlations between the age‐standardised COPD separation rates and SES across LGAs (r = ?0.60) and Regions (r = ?0.89). Analysis of readmissions (r = ?0.49), mortality data (r = ?0.51) and the burden of disease data (r = ?0.39) also showed significant inverse associations between COPD and SES. Conclusions and implications: Victorians living in the most disadvantaged areas have a greater burden from COPD, highlighting a need to prioritise public health services interventions to improve outcomes.     

The Impact of School Socioeconomic Status on Student Lunch Consumption after Implementation of the Texas Public School Nutrition Policy*

BACKGROUND: This study compares the impact of the Texas Public School Nutrition Policy on lunch consumption of low‐ and middle‐income students in sixth through eighth grades. METHODS: Students in 1 middle socioeconomic status (SES) and 1 low SES school completed lunch food records before (2001/2002) and after (2005/2006) implementation of the Texas policy. Students recorded amount and source of foods/beverages consumed. Two‐way analyses of variance with year and school SES as factors were performed to compare consumption by school SES before and after implementation of the Texas policy. RESULTS: Regardless of year, the low SES group consumed less fat, sweetened beverages, and candy and more vitamin C and calcium than the middle SES group. There were more significant improvements in dietary patterns for the middle SES school students post‐policy, particularly from the National School Lunch Program (NSLP) meal. The middle SES school students reported significantly higher percentages of less healthy items from home post‐policy. CONCLUSIONS: Overall, low SES school students consumed more healthy lunches at school compared with middle SES school students, and the Texas policy improved middle SES school student dietary intakes. Whether the dietary behaviors in school influence dietary intake for the entire day is unknown.     

The Impact of the COVID-19 Pandemic on Food Distribution at Emergency Food Assistance Organizations in the Southwestern United States: A Qualitative Investigation

This study aimed to identify changes in food distribution operations at emergency food assistance organizations (EFAOs) during the COVID-19 pandemic. EFAOs across the Houston metro area, TX (human service centers and food pantries) as well as the Houston Food Bank (HFB) participated in the qualitative study. Data were collected via individual semi-structured interviews and focus group (December 2020–February 2021), and coded using semi-structured thematic analysis. Categories were pre-identified based on the interview questions. Direct quotes supported subcategories. Directors from 18 EFAOs were interviewed; 8 HFB leadership staff participated in a focus group. Four major categories of change due to COVID-19 included new safety measures, changes in food distribution process, changes in volunteerism and staffing, and changes in amounts of food distributed. This study helps identify susceptibilities in EFAOs’ food distribution chain should be addressed to manage future emergency food insecurity crises more effectively. An understanding of the changes/challenges incurred by EFAOs during the COVID-19 pandemic can inform policymakers to ensure local food distribution organizations are prepared to fill the needs during future a crisis of food insecurity.     

Nutrition-related knowledge, beliefs and practices of Australian nursing staff

Objective: The purpose of the study was to examine the general food and nutrition‐related beliefs and knowledge of nursing professionals attending post‐partum women. Design: Data were collected by self‐administered questionnaire. Subjects: Three hundred and sixty‐two hospital‐based nursing staff responsible for the care of post‐parturient women. Setting: Eight metropolitan and regional hospitals in Queensland and three maternity hospitals in Canberra. Main outcome measures: Beliefs, opinions and intentions relating to food, nutrition and weight; knowledge of requirements of core foods; and sources of nutrition information. Statistical analysis: Standard statistical tests were used to measure frequencies and assess bivariate relationships. Results: Almost all participants (97.8%) were confident they could give good advice to their patients about a healthy balanced diet. The majority (65.5%) reported providing such advice at least weekly, 27.9% daily, and 19.5% rarely or never gave nutritional advice. The food‐related beliefs of most participants (>85%) were in line with current knowledge for 78% of questions. However, their knowledge of core food requirements for adults was inadequate; only 0.6% gave correct answers to all four food intake questions, 16.8% gave three correct answers, 62% two and 20.7% one correct answer. The most commonly cited sources of nutrition information were professional training (51.4%), reading (38.7%), media (14.9%), self‐education and work‐related experience (10.8%), dietitian (10.5%), school (7.5%), family (6.4%) and dieting (5.0%). Conclusion: Nursing staff frequently provide nutritional advice to post‐partum women. There is a need to ensure such information is accurate. Further research should explore ways in which this can be achieved.     

Socioeconomic differences in food preference and their influence on healthy food purchasing choices

Background: Studies have shown that socioeconomic groups differ in their dietary behaviours, and it has been suggested that these differences partly account for health inequalities between social groups. To-date, however, we have a limited understanding of why socioeconomic groups differ in their dietary behaviours. This paper addresses this issue by examining the relationship between socioeconomic status, food preference (likes and dislikes) and the purchase of 'healthy' food (i.e. food consistent with dietary guideline recommendations). Methods: This study was based on a dual-sample, dual-method research design. One sample was systematically selected from the Australian Commonwealth electoral roll and the data collected using a mail-survey methodology (81% response rate, n =403). The second consisted of a convenience sample of economically disadvantaged people recruited via welfare agencies (response rate unknown, n =70). A mail survey methodology was deemed inappropriate for this sample, so the data were collected by personally delivering the questionnaire to each respondent. Results: Socioeconomic groups differed significantly in their food purchasing choices and preferences. The food choices of respondents in the welfare sample were the least consistent with dietary guideline recommendations, and they reported liking fewer healthy foods (all results were independent of age and sex). Notably, socioeconomic differences in preference explained approximately 10% of the socioeconomic variability in healthy food purchasing behaviour. Conclusion: Whilst it is not clear why socioeconomic groups differ in their food preferences, possible reasons include: reporting bias, differential exposure to healthy food as a consequence of the variable impact of health promotion campaigns, structural and economic barriers to the procurement of these foods, and subculturally specific beliefs, values, meanings, etc.