A Healthier Diet Costs $1.50 Per Day

See Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis by Mayuree Rao1, Ashkan Afshin, Gitanjali Singh, and Dariush Mozaffarian. From BMJ Journals. Excerpts:

"Abstract

Objective To conduct a systematic review and meta-analysis of prices of healthier versus less healthy foods/diet patterns while accounting for key sources of heterogeneity.

Data sources MEDLINE (2000–2011), supplemented with expert consultations and hand reviews of reference lists and related citations.

Design Studies reviewed independently and in duplicate were included if reporting mean retail price of foods or diet patterns stratified by healthfulness. We extracted, in duplicate, mean prices and their uncertainties of healthier and less healthy foods/diet patterns and rated the intensity of health differences for each comparison (range 1–10). Prices were adjusted for inflation and the World Bank purchasing power parity, and standardised to the international dollar (defined as US$1) in 2011. Using random effects models, we quantified price differences of healthier versus less healthy options for specific food types, diet patterns and units of price (serving, day and calorie). Statistical heterogeneity was quantified using I² statistics.

Results 27 studies from 10 countries met the inclusion criteria. Among food groups, meats/protein had largest price differences: healthier options cost $0.29/serving (95% CI $0.19 to $0.40) and $0.47/200 kcal ($0.42 to $0.53) more than less healthy options. Price differences per serving for healthier versus less healthy foods were smaller among grains ($0.03), dairy (−$0.004), snacks/sweets ($0.12) and fats/oils ($0.02; p<0 .05="" 2000="" adjustment="" and="" bottom="" comparing="" cost="" day="" diet="" diets="" differences="" different="" each="" extremes="" food-based="" for="" healthfulness="" healthier="" in="" intensity="" juice="" kcal="" more.="" not="" nutrient-based="" of="" p="" patterns="" per="" price="" quantile:="" quantile="" results.="" significant="" significantly="" similar="" soda="" to="" top="" vs="" was="" whereas="" yielded="">

Conclusions This meta-analysis provides the best evidence until today of price differences of healthier vs less healthy foods/diet patterns, highlighting the challenges and opportunities for reducing financial barriers to healthy eating.

Conclusions

In sum, our findings provide the most complete evidence until today on price differences of healthier foods and diet patterns, while also highlighting the importance of carefully considering the metric of healthfulness, intensity of contrast and unit of comparison. Our results indicate that lowering the price of healthier diet patterns—on average ∼$1.50/day more expensive—should be a goal of public health and policy efforts, and some studies suggest that this intervention can indeed reduce consumption of unhealthy foods.24–26

It remains an open question as to why healthier diets cost more. Some have argued that US agricultural subsidies for commodities (eg, corn and soy) lower the price of less healthy, more processed foods compared with unprocessed foods.27 However, careful economic analyses demonstrate that the main impact of such subsidies is a direct income transfer to farmers, with little influence on retail prices; and that tariffs and other protectionist policies are actually raising the prices of many commodities such as sugar.28–30 Conversely, many decades of policies focused on producing inexpensive, high volume commodities have led to a complex network of farming, storage, transportation, processing, manufacturing and marketing capabilities that favour sales of highly processed food products for maximal industry profit.31 Based on these experiences, efforts to create an infrastructure and commercial framework that facilitates production, transportation and marketing of healthier foods could increase the availability and reduce the prices of more healthful products.31 Taxation of less healthy foods and subsidies for healthier foods would also be an evidence-based intervention to balance price differences.31

Other potential barriers to a healthier diet exist, such as availability and cultural acceptability.

However, our findings suggest that for socioeconomically disadvantaged populations, the relatively higher cost of healthy foods may be an impediment to eating better. On the other hand, Americans at all income levels allocate too little of their food budgets towards healthy foods.32 A daily price difference of ∼$1.50 translates to ∼$550 higher annual food costs per person. For many low-income families, this additional cost represents a genuine barrier to healthier eating. Yet, this daily price difference is trivial in comparison with the lifetime personal and societal financial burdens of diet-related chronic diseases.33  34 For example, suboptimal diet quality was recently estimated to account for 14% of all disability-adjusted life years in 2010 in the USA35; if translated to a proportion of national health expenditures in 2012,36 this corresponds to diet-related healthcare costs of $393 billion/year or more than $1200/year for every American. Our findings highlight the nuanced challenges and the opportunities for reducing financial barriers to healthy eating."