The availability and cost of healthier food alternatives

BACKGROUND: Many people, especially low-income consumers, do not successfully follow dietary recommendations to eat more whole grains and less fat and added sugar. The food environment may have a significant impact on the choice by low-income consumers to eat healthier foods, as both the availability and price of healthier food items may limit their ability to eat a healthier diet. We investigated the cost and availability of a standard market basket of foods, and a healthier basket that included low-fat meat and dairy and whole grain products. METHODS: Market-basket surveys were conducted in 25 stores in Los Angeles and Sacramento. Stores were selected from neighborhoods that were varied by income and surveyed three times from September 2003 to June 2004. The average cost of a standard market basket (based on the U.S. Department of Agriculture's Thrifty Food Plan [TFP]) and a healthier market basket was calculated from these prices and compared using a standard t-test to determine if they were significantly different from each other. The analysis was conducted in 2005. RESULTS: In neighborhoods served by smaller grocery stores, access to whole-grain products, low-fat cheeses, and ground meat with <10% fat is limited. Among all items that were unavailable, 64% were in small grocery stores. For the 2-week shopping list, the average TFP market-basket cost was $194, and the healthier market-basket cost was $230. The average cost of the healthier market basket was more expensive by $36 due to higher costs of whole grains, lean ground beef, and skinless poultry. The higher cost of the healthier basket is equal to about 35% to 40% of low-income consumers' food budgets of $2410 a year. CONCLUSIONS: The lack of availability in small grocery stores located in low-income neighborhoods, and the higher cost of the healthier market basket may be a deterrent to eating healthier among very low-income consumers. Public policies should take the food environment into account in order to develop successful strategies to encourage the consumption of healthier foods.     

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.     

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.     

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.     

Is price a barrier to eating more fruits and vegetables for low-income families?

OBJECTIVE: To determine if price is a barrier to fruit and vegetable consumption for low-income families by comparing the average cost of a market basket of fruits and vegetables from the Thrifty Food Plan and the Dietary Guidelines for Americans 2005 (2005 Dietary Guidelines), investigating variations in price by neighborhood income and by type of supermarket, and estimating the influence of a 2005 Dietary Guidelines fruit and vegetable basket on the food budget of a low-income family. DESIGN: A market basket survey was conducted at 25 supermarkets across three time periods to allow for seasonal variation in produce prices. SETTING: Stores were selected from census tracts with a variety of income levels in Sacramento, CA, and Los Angeles, CA. MAIN OUTCOME MEASURES: The average cost of a Thrifty Food Plan and 2005 Dietary Guidelines market basket for fruits and vegetables. STATISTICAL ANALYSES PERFORMED: Student t tests were used to compare the mean cost of market baskets. RESULTS: The 2005 Dietary Guidelines market basket cost 4% less than the Thrifty Food Plan (P<0.001), and was significantly less expensive in low-income areas at 65 dollars (P<0.05), and in bulk supermarkets at 59 dollars (P<0.05). The 2005 Dietary Guidelines market basket would require a low-income family to devote 43% to 70% of their food budget to fruits and vegetables. CONCLUSIONS: Public policies should examine ways to make fruits and vegetables more affordable to low-income families.     

Adelaide Healthy Food Basket: A survey on food cost, availability and affordability in five local government areas in metropolitan Adelaide, South Australia

Aim: There is evidence that some people in Australia do not have access to affordable, healthy foods. Information on food accessibility and affordability is essential in pubic health nutrition to assist in policy making and determining areas of intervention. The aim of the present study assess and compare the cost, availability and affordability of a standardised healthy food basket (HFB) in five local government areas (LGAs) in metropolitan Adelaide. Methods: Five LGAs in metropolitan Adelaide were selected based on ranges of socioeconomic status (SES). A reference family was used as the basis for the costing a HFB. Prices of food items were collected in selected suburbs in May, August and September in 2005. Cost of the Adelaide HFB was compared with welfare payment and average weekly earnings (AWE). Results: Average weekly cost of Adelaide HFB was $245.63 for the 11 suburbs: lowest in Coolabah, in low SES City of Fordlow ($224.17), and highest in Banksia, in high SES City of Sidehigh ($271.87). The proportion of AWE taken up by the average HFB was 35%, while that of the welfare payments was 31%. Conclusion: The study showed that the cost of HFB was lower in low‐SES suburbs. Items in the HFB were found in most supermarkets surveyed; therefore, availability of healthy food at this geographical level is not a concern. However, the study highlighted the proportionately high costs of a healthy diet for families on welfare or on a single income based on AWE, which needs to be considered in programs encouraging healthy food choices.     

Facebook Is an Effective Strategy to Recruit Low-income Women to Online Nutrition Education

ObjectiveNutrition education research recruitment expense and effort are substantial; sample selection is crucial for intervention assessment. Effectiveness and cost of Facebook to recruit low-income women to an online nutrition program were examined, including biopsychosocial characteristics of Facebook responders.MethodsAn ad appeared on the Facebook page of low-income women, 18-45 years old, living in Pennsylvania to invite access to an online nutrition program. Eligible persons completed surveys about food-related behaviors including eating competence, food security, and assistance program use.ResultsOf 465 people who clicked on the ad, 81 completed the eligibility survey, and 62 were eligible; 52 completed a preprogram survey. Completers were mostly white (79%), overweight/obese (mean body mass index 36.2 ± 12.9), and not eating competent (75%). Low-income status was identified for 75% (n = 39) of completers. Total recruitment cost over 19 days was $596.71.Conclusions and ImplicationsFacebook appears to be an effective tool to recruit low-income women to nutrition education projects.     

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.     

Peer Reviewed: Availability,Affordability, and Accessibility of a Healthful Diet in a Low-Income Community,Central Falls,Rhode Island, 2007-2008

Background

Many Americans have diets that do not meet the dietary guidelines set by the US Department of Agriculture (USDA). Additionally, low-income people have the highest rates of obesity and have difficulty accessing the necessary foods for maintaining a healthful diet.

Context

In December 2007 and January 2008, 21 retail food stores in Central Falls, Rhode Island, where residents were predominantly low-income Hispanics, were evaluated for the availability and costs of foods that fulfill the USDA''s Thrifty Food Plan (TFP) guidelines.

Methods

Each surveyed store was evaluated for variety and weekly cost of 3 different types of market baskets (2 families and an elder). Each store''s proximity to public transportation was estimated by using geographic information systems mapping.

Outcome

Only 2 stores in Central Falls and the discount supermarket in an adjacent city, Pawtucket, carried enough variety of foods to fill the TFP basket. At the 2 stores, costs were up to 40% higher, and at the discount store, costs were up to 18% cheaper, than the national average. Each of the stores was accessible by public transportation.

Interpretation

Meeting the USDA TFP guidelines is difficult in this low-income, predominantly Hispanic city. Although the components of the TFP are available, high prices may make a nutritious diet unaffordable.     

Direct Determinations of the Fatty Acid Composition of Daily Dietary Intakes Incorporating Nutraceuticals and Functional Food Strategies to Increase n-3 Highly Unsaturated Fatty Acids

Objective: North American diets are low in eicosapentaenoic acid (20:5n-3, EPA) and docosahexaenoic acid (22:6n-3, DHA). This investigation aims to assess the ability to increase EPA and DHA in the Canadian diet using traditional whole food, functional food or nutraceutical strategies.

Methods: A typical Canadian diet (TC) was compared to four diets enriched with EPA and DHA but with similar caloric and macronutrient composition: a nutraceutical fish oil capsule diet (FO), an EPA + DHA-enriched functional foods diet (ED), a traditional whole foods (fish) diet (TW) and a comprehensive diet combining fish with functional foods (FF) containing EPA + DHA and α-linolenic acid. Direct biochemical quantitations were performed for energy, protein, carbohydrate (proximate analysis) and fat (gas chromatography). Costs of each diet and EPA + DHA source were assessed.

Results: The FO (1.03 ± 0.01g EPA + DHA), ED (0.59 ± 0.02g), TW (3.23 ± 0.09g) and FF (3.15 ± 0.06g) diets provided significantly higher amounts of EPA + DHA compared to the TC diet (0.08 ± 0.01g). Using the TC diet as a baseline, the daily cost increase for each revised diet was $0.53 (FO), $0.82 (TW), $0.93 (ED) and $1.62 (FF). The cost per gram of EPA + DHA was lowest for fish oil nutraceuticals ($0.53/g), followed by fish (～$1.05/g).

Conclusions: The EPA and DHA content of daily diets can be increased significantly and cost effectively using nutraceuticals, functional foods and whole foods. Several North American EPA + DHA recommendations for healthy individuals can be met using these strategies and American Heart Association recommendations for secondary coronary heart disease prevention can be met via traditional whole food, nutraceutical or combination approaches.     

Economic burden of hospital admissions for patients with acute bacterial skin and skin structure infections in the United States

ABSTRACT

Objectives: We estimated the total US hospital costs associated with acute bacterial skin and skin structure infection (ABSSSI) admissions as well as the admissions that may have been potential candidates for outpatient parenteral antimicrobial therapy (OPAT).

Methods: We assessed inpatient admissions for ABSSSI from the Premier database (2011–2014), focusing on all admissions of adults with length of stay (LOS) ≥ 1 days and a primary diagnosis of erysipelas, cellulitis/abscess, or wound infection. We performed a detailed analysis of 2014 admissions for patient, treatment, hospital, and economic characteristic variables. Using published selection criteria, we identified a subset of patients admitted in 2014 who may have been potential candidates for OPAT.

Results: We analyzed 277,971 admissions. In 2014, most admissions were for cellulitis without major complications or comorbidities; mean ± SD LOS was 4.0 ± 3.0 days, and total hospital cost per admission was $6400 ± $6874, 54% of which was attributable to room costs. Among 2014 admissions, 14% involved patients with clinical characteristics suggesting that they were consistent with guideline recommendations for exclusive treatment with OPAT. Compared with all admissions in the year, these admissions were of younger patients (aged 50 vs. 55 years), admitted more frequently for cellulitis (90% vs. 70%), with shorter LOS (2.8 ± 1.8 days), and lower mean total hospital cost per admission ($4080 ± $3066).

Conclusions: Admissions for ABSSSI impose a substantial cost to US hospitals, with half of costs attributable to room costs. When extrapolated to all US patients admitted to the hospital for ABSSSI during 2014, had OPAT guidelines been universally followed, admissions may have been reduced by 14%, thereby saving US hospitals $161 million.     

Healthcare Cost Reductions Associated with the Use of LAI Formulations of Antipsychotic Medications Versus Oral Among Patients with Schizophrenia

Real-world medication adherence and healthcare costs of patients with schizophrenia initiating long-acting injectable (LAI) vs. oral antipsychotics were compared. Patients with schizophrenia initiating LAI or oral antipsychotics (index event) were identified from MarketScan Commercial and Medicare claims databases and their medication possession ratios (MPR), pre- and post-index costs for inpatient/outpatient care were compared. Of 3,004 patients, 394 initiated LAI antipsychotics and 2,610 oral antipsychotics. Post-index, the mean MPR was greater for the LAI cohort (0.67?±?0.34 vs. 0.56?±?0.35; p?<?0.001). Schizophrenia-related hospital costs for LAI users were reduced during the follow-up period in comparison to the pre-index period, but were increased for patients using oral antipsychotics (-$5,981?±?$16,554 vs. 758?±?14,328, p?<?0.001). The change in costs of outpatient care also favored LAI medications ($134?±?8,280 vs. 658?±?3,260, p?=?0.023). Drug costs of LAI antipsychotics were higher ($4,132?±?4,533 vs. 2,562?±?2,714, p?<?0.001). Schizophrenia patients initiating LAI antipsychotics incur less healthcare costs in comparison to patients initiating oral antipsychotics.     

Analysis of Asthma-Related Costs and Patterns of Resource Utilization in a Managed-Care Population

Objectives: To identify the asthma prevalence rate, the total healthcare and asthma-related treatment costs, and the medical and pharmacy costs associated with different asthma medication usage patterns in a managed-care organisation (MCO). Study design and participants: The medical and pharmacy claims databases from a 400 000 member MCO were used. The medical claims database was searched from 1994 to 1996 for patients having at least one asthma medical claim in either the first or second diagnosis field of the medical claims, and the total healthcare and asthma-related costs were determined. A subpopulation with a more restrictive asthma definition was identified and their costs were also determined. In addition, the patterns of drug treatment were identified. Study perspective: MCO perspective. Results: The mean total healthcare cost of caring for patients with asthma was significant and approximately twice the mean cost of all patients enrolled in the MCO. Using a broad definition of asthma, the mean (± standard deviation) annual total per patient healthcare cost was $US2511 ± 7314 and the annual asthma-related cost was $US679 ± 2247 (1996 values). Using a more restrictive definition of asthma, the mean annual total per patient healthcare cost was $US2653 ± 5268 and the asthma-related cost was $1026 ± 2447. There appeared to be a low overall use of asthma medications, especially anti-inflammatory formulations; <3% of patients with asthma were high users of anti-inflammatory inhalers. Conclusions: Patients with asthma are costly to managed-care organizations. Asthma-related costs constitute a minority (<30%) of the costs of caring for these patients, and under utilization of anti-inflammatory products by patients is widespread. Further research is needed to assess the cost impact of different asthma treatment patterns.     

Select Food Group Intake of US Children Aged 2 to 4 Years by WIC Participation Status and Income

BackgroundFood group and nutrient priorities for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Package IV for children aged 2 to 4 years were described in the 2017 review of the WIC Food Package. Research has evaluated priority nutrient intake, but priority food group intake remains unknown.ObjectivesTo compare mean intake of priority food groups/subgroups of WIC children to WIC-eligible nonparticipants and higher income children. Further, we hoped to assess differences in percent contribution of food subgroups to total food group intake by WIC participation status and income.DesignCross-sectional study conducted using data from the 2011-14 National Health and Nutrition Examination Survey.Participants/settingOne thousand forty-seven children aged 2 to 4 years.Main outcome measuresMean intake reported in cup equivalents and ounce equivalents. We also looked at mean percent that food subgroups contributed to total intake within a food group. Analyses were performed for high and low priority food groups/subgroups: high = seafood, total vegetables, dark green vegetables, red/orange vegetables, whole grains, and nuts/seeds/soy; low = total starchy vegetables, other vegetables, legumes computed as vegetables, total dairy, and total protein foods.Statistical analyses performedMultivariable linear regression analysis was used evaluate the relationship between income/WIC participation and mean intake/percent food subgroups contributed to total food group intake.ResultsAmong low-income WIC-eligible children, participation in WIC was associated with greater mean intake of red/orange vegetables (0.18 ± 0.03 vs 0.01 ± 0.06 c equivalents; P < 0.05) and legumes (0.07 ± 0.01 vs 0.01 ± 0.02 c equivalents; P < 0.01). No differences in mean intake were observed between WIC children and higher income children. Grain intake of WIC children was composed of a higher percentage of whole grains (19.1% ± 1.6% vs 13.2% ± 1.5%; P < 0.01) compared with higher income children. The percent vegetable subgroups contributed to total vegetable intake varied by income; no differences were observed for dairy or protein subgroups.ConclusionsAmong low-income children, participation in WIC was associated with greater intake of certain vegetables. Participation in WIC may also help close the diet quality gap between low-income and higher income children for priority foods targeted by the WIC food package. Future research should explore socioeconomic disparities in intake of nutrient-poor foods.     

Yes We Can: Eating Healthy on a Limited Budget

Objective

This study determined how people who live in low-income households can consume an affordable, nutritious diet.

Food Variety and Dietary Diversity as Indicators of the Dietary Adequacy and Health Status of an Elderly Population in Sharpeville,South Africa

ABSTRACT

This cross-sectional, analytical study was a comprehensive health assessment focusing on dietary quality of 170 randomly selected elderly respondents in Sharpeville, South Africa. The methods included a sociodemographic, health food frequency questionnaire, 24 h-recall questionnaires, and anthropometric and biochemical measurements. The low mean±standard deviation (SD) dietary diversity score (3.41±1.34) and food variety score (4.77±2.2) compared with poverty parameters confirmed household food insecurity in this community. Although three (n = 99, 58.6%) or two (n = 49, 28.9%) daily meals were mostly consumed, these were mainly carbohydrate-based and nutrient-deficient. The cereal group (2.01±0.81) had the highest mean food variety score ±SD, followed by dairy (0.62±0.53) and flesh foods (0.40±0.53). When a mean adequacy ratio of 70% was used as a cut-off point for nutrient adequacy, it was found that the food variety score must be eight or higher and the dietary variety score must be at least six. These indicators thus have a high ability to identify those respondents with an inadequate diet but lower ability to identify those respondents with a nutritionally adequate diet. The data further showed a trend that with a higher food variety and dietary diversity, a better mean adequacy ratio is reached for this low-income group of elderly subjects. In conclusion, the results showed that food variety and dietary diversity scores give a fairly good assessment of the adequacy of the diet, and scoring dietary diversity is a significant, yet simple tool to identify elderly persons at risk of food and nutrition insecurity.     

Extending Delivery Coverage to Include Prenatal Care for Low-Income,Immigrant Women Is a Cost-Effective Strategy

ObjectiveTo compare the outcomes and cost effectiveness of two alternate policy strategies for prenatal care among low-income, immigrant women: coverage for delivery only (the federal standard) and prenatal care with delivery coverage (state option under the Children's Health Insurance Program).MethodsA decision-analytic model was developed to determine the cost effectiveness of two alternate policies for pregnancy coverage. All states currently provide coverage for delivery, and 19 states also provide coverage for prenatal care. An estimated 84,000 unauthorized immigrant women have pregnancies where no prenatal care is covered. Our outcomes were costs, quality-adjusted life-years, and cases of cerebral palsy and infant death before age 1. Model inputs were obtained from a database of Oregon Medicaid claims and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed.ResultsExtending prenatal coverage is a cost-effective strategy. Providing prenatal care for the 84,000 women annually who are currently uninsured could prevent 117 infant deaths and 34 cases of cerebral palsy. Prenatal care coverage costs $380 more per woman than covering the delivery only. For every 865 additional women receiving prenatal care, one infant death would be averted, at an average cost of $328,700. Cost-effectiveness acceptability curve analyses suggest a 99% probability that providing prenatal care is more cost effective at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year.ConclusionsExtending prenatal care to low-income, immigrant women, regardless of citizenship status, is a cost-effective strategy.     

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.