Background Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia, and is inequitably distributed. As the price of healthy foods is a perceived barrier to improved diets, evidence on the cost and affordability of current (unhealthy) and recommended (healthy, more equitable and sustainable) diets is required to support policy action. Methods This study applied the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to measure the cost, cost differential and affordability of current and recommended diets for a reference household in Queensland, Australia. Food prices were collected in 18 randomly selected locations stratified by area of socioeconomic disadvantage and remoteness. Diet affordability was calculated for three income categories. Results Surprisingly, recommended diets would cost 20% less than the current diet in Queensland as a whole. Households spent around 60% of their food budget on discretionary choices (that is, those not required for health that are high in saturated fat, added sugar, salt and/or alcohol). Queensland families would need to spend around 23% of their income on recommended diets. However, recommended diets would not be affordable in low socioeconomic or very remote areas, costing 30 and 35% of median household income respectively. The government supplements due to the SARS-CoV-2 pandemic would improve affordability of recommended diets by 29%. Conclusions Study findings highlight that while price is one factor affecting consumer food choice, other drivers such as taste, convenience, advertising and availability are important. Nevertheless, the study found that recommended diets would be unaffordable in very remote areas, and that low-income families are likely experiencing food stress, irrespective of where they live in Queensland. Policy actions, such as increasing to 20% the current 10% tax differential between basic healthy, and unhealthy foods in Australia, and supplementing incomes of vulnerable households, especially in remote areas, are recommended to help improve diet equity and sustainability, and health and wellbeing for all.

Background The perception that healthy foods are more expensive than unhealthy foods has been reported widely to be a key barrier to healthy eating. However, assessment of the relative cost of healthy and unhealthy foods and diets is fraught methodologically. Standardised approaches to produce reliable data on the cost of total diets and different dietary patterns, rather than selected foods, are lacking globally to inform policy and practice. Methods This paper reports the first application, in randomly selected statistical areas stratified by socio-economic status in two Australian cities, of the Healthy Diets Australian Standardized Affordability and Pricing (ASAP) method protocols: diet pricing tools based on national nutrition survey data and dietary guidelines; store sampling and location; determination of household incomes; food price data collection; and analysis and reporting. The methods were developed by the International Network on Food and Obesity/NCD Research, Monitoring and Action Support (INFORMAS) as a prototype of an optimum approach to assess, compare and monitor the cost and affordability of diets across different geographical and socio-economic settings and times. Results Under current tax policy in Australia, healthy diets would be 15–17% less expensive than current (unhealthy) diets in all locations assessed. Nevertheless, healthy diets are likely to be unaffordable for low income households, costing more than 30% of disposable income in both cities surveyed. Households spent around 58% of their food budget on unhealthy food and drinks. Food costs were on average 4% higher in Canberra than Sydney, and tended to be higher in high socioeconomic locations. Conclusions Health and fiscal policy actions to increase affordability of healthy diets for low income households are required urgently. Also, there is a need to counter perceptions that current, unhealthy diets must be less expensive than healthy diets. The Healthy Diets ASAP methods could be adapted to assess the cost and affordability of healthy and unhealthy diets elsewhere.

Many historical, environmental, socioeconomic, political, commercial, and geographic factors underscore the food insecurity and poor diet-related health experienced by Aboriginal people in Australia. Yet, there has been little exploration of Aboriginal food practices or perspectives on food choice recently. This study, with 13 households in remote communities on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, fills this gap using ethnographic and Indigenist methods. Results highlight Anangu resourcefulness, securing food despite poverty and adversity, and provide unique insights into factors influencing the three major types and range of dietary patterns identified. These factors include household economic cycles and budgeting challenges; overcrowding and family structures, mobility and ‘organization’; available food storage, preparation and cooking infrastructure; and familiarity and convenience. Structural and systemic reform, respecting Aboriginal leadership, is required to improve food security.

Background: Comprehensive nutrition policies are required urgently to help transform food systems to more equitably deliver healthy, sustainable diets. Methods: Literature was searched systematically for nutrition policies of the then 34 Organisation for Economic Cooperation and Development (OECD) members as part of a scoping study. Recently, results were re-analysed, against the NOURISHING framework. Results: Twenty-three nutrition policy documents were identified for 19 jurisdictions. Most policy actions focused on the behaviour change communication domain: all (100%) promoted consumption of ‘healthy’ choices. In the food environment domain, most policies included food labelling (84%), product reformulation (68%), providing healthy foods in public institutions (89%, mainly schools), and restricting food advertising (53%), largely through voluntary codes. Relatively few economic tools were being applied. There was very little focus on reducing consumption of ‘unhealthy’ food or drinks. Not all nutrition policy actions identified were covered by the NOURISHING framework. Conclusion: The NOURISHING framework could be expanded to more comprehensively encompass the health and sustainability dimensions of food systems, eg, by detailing optimum governance arrangements. As recently as seven years ago, half of the most developed economies globally did not have a publicly available nutrition policy. Existing policies were dominated by conventional nutrition education approaches, while policy actions targeting food environments, and regulatory and legislative reforms, were rare. This is consistent with a neo-liberal approach centring individual responsibility. No examples of the multi-strategy, inter-sectoral, coordinated, evidence-based policies required to drive systemic transformation were identified. Therefore, it is not surprising that rates of obesity and diet-related conditions have continued to rise in these jurisdictions, nor that governments are currently off-track to deliver the systemic transformation required to meet relevant global health and sustainable development goals.

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.