Research article
The Availability and Cost of Healthier Food Alternatives

https://doi.org/10.1016/j.amepre.2005.08.039Get rights and content

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.

Introduction

Dietary recommendations encourage people to protect themselves against chronic diseases such as diabetes, hypertension, stroke, and some types of cancer by increasing their intake of whole grains, fruits, and vegetables, and by reducing their intake of fat and added sugar.1, 2, 3, 4 Meeting the dietary recommendations does not necessarily require consumers to make major changes in their diet. Minor changes can be effective, such as substituting whole wheat bread for white bread, lean ground beef for regular ground beef, or low-fat milk for whole milk. Few people, however, successfully follow the dietary recommendations, and low-income consumers are even less likely to meet them. For instance, 10% of upper-income adults eat three or more servings of whole grains each day, compared to 5% for low-income adults.5 Higher-income adults come closer to consuming the recommended daily amounts of fruits and vegetables.6

The food environment may have a significant impact on the ability of low-income consumers to eat healthier foods. When asked, low-income consumers frequently cite unavailability and higher prices among the constraints to eating healthier.7 However, no studies have methodically examined whether healthier substitutes are readily available in low-income neighborhoods or at what price. If healthier food items are frequently unavailable, or prices are significantly higher, then nutrition education targeted at low-income consumers may be ineffectual.

Market-basket studies are frequently used to assess the availability and prices of food items. In previous studies, low-income consumers have healthy food items available to them if they have access to a grocery store.8, 9, 10 These studies have for the most part ignored the nutritional characteristics of the food being sold. This has led to a potentially erroneous conclusion that low-income consumers also have sufficient access to the healthier alternatives, and is at odds with their assertions that the healthier alternatives are in fact not readily available.

Price may also be a factor in the choice to eat healthier. Drewnowski et al.11 argue that the low price of energy-dense food encourages low-income Americans to consume an unhealthy diet. Recent research on the food environment has shown that people are sensitive to the relative price of healthier food items. One study suggests that price is a significantly stronger influence on healthy food choices compared to labeling healthy foods.12 In an experiment manipulating prices and labels on foods sold in vending machines, price reductions of 10%, 25%, and 50% on lower-fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions.

The research on market-basket studies has focused on whether prices paid in low-income neighborhoods reflect the same prices used to determine public food assistance benefits.13, 14 These studies are usually based on the U.S. Department of Agriculture’s Thrifty Food Plan (TFP).15 The TFP is a meal plan that demonstrates how a diet that meets the minimum recommendations of the 1995 Dietary Guidelines for Americans16 may be achieved by a family of four on a modest budget or by food stamp recipients. However, the TFP does not have the whole grains or the leanest meats recommended for a healthier diet. No research to date has examined the cost of healthier alternatives to the TFP.

For this research, a market-basket study was completed to compare the availability and cost of a standard market basket to a market basket with healthier substitutes. This analysis was conducted to answer two research questions: (1) What is the availability of healthier foods in low-income compared to higher-income neighborhoods? (2) Does a healthier food basket cost more than the standard food basket?

Section snippets

Methods and Materials

The market-basket study involved surveyors going into grocery stores in the areas of interest and collecting prices for a list of food items from each store. The average cost of the standard TFP market basket and the healthier market basket was calculated from these prices and compared using a standard t-test.

Availability

The items most likely to be missing were whole wheat breads and grain products, and ground beef with ≤10% fat (Table 2). Six stores were missing whole wheat spaghetti; three stores were missing whole wheat English muffins, higher-fiber hamburger buns, ground beef with ≤10% fat, and low-fat cheddar cheese; and two stores did not have whole wheat bagels and frozen fish filets (unbreaded). Except for the frozen fish filets, all items that were never available were recorded for stores located in

Discussion

For people in higher-income neighborhoods, access to the healthier substitutes recommended for a healthy diet is as easy as their access to a supermarket. Almost all supermarkets stock a variety of the recommended substitutes. However, small independent grocery stores, usually found in low-income neighborhoods, often do not have in stock the higher-fiber breads and whole grains, or ground beef with ≤10% fat. The items may never be available, or available only some of the time. Within these

References (19)

There are more references available in the full text version of this article.

Cited by (364)

View all citing articles on Scopus

The full text of this article is available via AJPM Online at www.ajpm_online.net.

View full text