Affordability of current, and healthy, more equitable, sustainable diets by area of socioeconomic disadvantage and remoteness in Queensland: insights into food choice

Abstract

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.

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

“…The influence of such factors might explain why households in Greater Brisbane continue to purchase the current diet despite the recommended diet being 19% less expensive. This corresponds to findings of prior research using the Healthy Diets ASAP protocol in Australia that has shown that, under current policy settings, which include the exemption of "basic, healthy foods" from the Goods and Services Tax (GST) [9,10], the current diet is from 14% to 23% more expensive than the recommended diet in Brisbane [11,12], Canberra and Sydney [10], regional Victoria [13], Aboriginal communities in remote Australia [8] and in two large supermarket chains nationally [14].…”

“…The protocol comprises five sections: standardised current (unhealthy) and recommended (healthy, equitable and more sustainable) diet pricing tools; store location and sampling; calculation of household incomes; food price data collection; and analysis and reporting [11]. The protocol has been described in detail elsewhere [11] and applied in multiple studies [8][9][10][11][12][13][14].…”

“…In 2020, because of public health measures including travel restrictions that were implemented due to the COVID-19 pandemic, food prices could not be collected outside Greater Brisbane. Therefore, only the 10 SA2 locations (and specific food outlets) surveyed in Greater Brisbane in the 2019 study [9] were included for comparison. At each location, two large supermarkets (one of each major supermarket chain), an independent grocer, a bakery, a fish and chip shop, two fast-food restaurants and one alcohol store were surveyed.…”

“…Less than one percent of Australians consume a diet consistent with recommendations in national guidelines [7]. While recent evidence indicates that recommended diets would be less expensive than current diets in Australia [8][9][10][11][12][13][14], recommended diets would not be affordable for low-income households [9,10].…”

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

“…Testing the low SEG protocol used prices from a major city location. Regional and/or remote areas are likely to experience higher food prices [51] and a relative lack of 'own brand' products and budget supermarkets [52]. Therefore, diet cost and affordability results in this study reflect a 'best case scenario' for low SEGs.…”