Purpose of Review
Food and beverage prices are major influences on dietary intakes. International health bodies recommend leveraging food prices to create healthier food environments. A policy review was conducted to understand the extent to which national nutrition and obesity prevention policy strategies within high-income countries (i) consider food price as a determinant of health and (ii) propose and implement policies to rebalance food pricing towards healthier options.
Policy strategies were inconsistent and fragmented in their inclusion of food prices as determinants of diet-related health. The equity benefits of pricing policies were often indicated. Fiscal measures and food subsidies in schools were the most commonly proposed and implemented pricing policies, predominantly used in Europe.
Price is a pertinent but underutilized policy lever in nutrition policy. Comprehensive food and beverage pricing strategies need to be identified, adopted and implemented to improve population diets for everyone.
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Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1923–94. https://doi.org/10.1016/S0140-6736(18)32225-6.
Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2019;393(10184):1958–72. https://doi.org/10.1016/S0140-6736(19)30041-8.
Stringhini S, Carmeli C, Jokela M, Avendaño M, Muennig P, Guida F, et al. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet. 2017;389(10075):1229–37.
Devaux M, Sassi F. Social inequalities in obesity and overweight in 11 OECD countries. Eur J Pub Health. 2013;23(3):464–9. https://doi.org/10.1093/eurpub/ckr058.
Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(9):873–98. https://doi.org/10.1161/cir.0000000000000228.
World Health Organization. Social Determinants of Health. https://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/. Accessed 01/09/19.
Marmot M, Atkinson T, Bell J, Black C, Broadfoot P, Cumberlege J et al. Fair Society, Healthy Lives. The Marmot Review: Strategic Review of Health Inequalities in England Post-2010. 2010.
Zorbas C, Palermo C, Chung A, Iguacel I, Peeters A, Bennett R, et al. Factors perceived to influence healthy eating: a systematic review and meta-ethnographic synthesis of the literature. Nutr Rev. 2018;76(12):861–74. https://doi.org/10.1093/nutrit/nuy043.
Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev. 2015;73(10):643–60. https://doi.org/10.1093/nutrit/nuv027.
•• Mackenbach JD, Nelissen KGM, Dijkstra SC, Poelman MP, Daams JG, Leijssen JB, et al. A systematic review on socioeconomic differences in the association between the food environment and dietary behaviors. Nutrients. 2019;11(9). https://doi.org/10.3390/nu11092215This recent systematic review outlines consistent evidence on the greater impact of economic aspects of the food environment on low compared to high-income groups.
Kreps D. A course in microeconomic theory. Princeton: Princeton University Press; 1990.
Milani C, Lorini C, Baldasseroni A, Dellisanti C, Bonaccorsi G. An Umbrella Review and Narrative Synthesis of the Effectiveness of Interventions Aimed at Decreasing Food Prices to Increase Food Quality. 2019;16(13):2346.
•• Afshin A, Penalvo JL, Del Gobbo L, Silva J, Michaelson M, O'Flaherty M, et al. The prospective impact of food pricing on improving dietary consumption: a systematic review and meta-analysis. PLoS One. 2017;12(3):e0172277. https://doi.org/10.1371/journal.pone.0172277This systematic review and meta-analysis quantifies the extent to which pricing changes impact consumption.
Niebylski ML, Redburn KA, Duhaney T, Campbell NR. Healthy food subsidies and unhealthy food taxation: A systematic review of the evidence. Nutrition. 2015;31(6):787–95. https://doi.org/10.1016/j.nut.2014.12.010.
Backholer K, Sarink D, Beauchamp A, Keating C, Loh V, Ball K, et al. The impact of a tax on sugar-sweetened beverages according to socio-economic position: a systematic review of the evidence. Public Health Nutr. 2016;19(17):3070–84. https://doi.org/10.1017/s136898001600104x.
Thow AM, Downs S, Jan S. A systematic review of the effectiveness of food taxes and subsidies to improve diets: understanding the recent evidence. Nutr Rev. 2014;72(9):551–65. https://doi.org/10.1111/nure.12123.
Afshin A, Penalvo J, Del Gobbo L, Kashaf M, Micha R, Morrish K, et al. CVD prevention through policy: a review of mass media, food/menu labeling, taxation/subsidies, built environment, school procurement, worksite wellness, and marketing standards to improve diet. Curr Cardiol Rep. 2015;17(11):98. https://doi.org/10.1007/s11886-015-0658-9.
Cornelsen L, Green R, Turner R, Dangour AD, Shankar B, Mazzocchi M, et al. What happens to patterns of food consumption when food prices change? Evidence from A Systematic Review and Meta-Analysis of Food Price Elasticities Globally. 2015;24(12):1548–59. https://doi.org/10.1002/hec.3107.
Wright A, Smith KE, Hellowell M. Policy lessons from health taxes: a systematic review of empirical studies. BMC Public Health. 2017;17(1):583. https://doi.org/10.1186/s12889-017-4497-z.
Hyseni L, Atkinson M, Bromley H, Orton L, Lloyd-Williams F, McGill R, et al. The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review. Eur J Clin Nutr. 2017;71(6):694–711. https://doi.org/10.1038/ejcn.2016.234.
Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: a systematic review. Prev Chronic Dis. 2017;14:E107. https://doi.org/10.5888/pcd14.170213.
von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, et al. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev. 2019;6(6):CD012292–CD. https://doi.org/10.1002/14651858.CD012292.pub2.
Using price policies to promote healthier diets. World Health Organization Regional Office for Europe. 2015.
McGill R, Anwar E, Orton L, Bromley H, Lloyd-Williams F, O'Flaherty M, et al. Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health. 2015;15:457. https://doi.org/10.1186/s12889-015-1781-7.
NOURISHING database. World Cancer Research Fund International. https://www.wcrf.org/int/policy/nourishing-database. Accessed 28 October 2019 2019.
INFORMAS - Benchmarking food environments. https://www.informas.org/about-informas/. Accessed 08/08/19.
Bösch S, Lobstein T, Brinsden H, Ralston J, Bull F, Willumsen J, et al. Taking action on childhood obesity report. Geneva: World Obesity Federation & World Health Organization; 2018.
Global action plan for the prevention and control of noncommunicable diseases 2013-2020. World health organization. Geneva, Switzerland. 2013.
Silver LD, Ng SW, Ryan-Ibarra S, Taillie LS, Induni M, Miles DR, et al. Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: a before-and-after study. PLoS Med. 2017;14(4):e1002283. https://doi.org/10.1371/journal.pmed.1002283.
Zhong Y, Auchincloss AH, Lee BK, Kanter GP. The short-term impacts of the Philadelphia beverage tax on beverage consumption. Am J Prev Med. 2018;55(1):26–34. https://doi.org/10.1016/j.amepre.2018.02.017.
Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. 2016;352:h6704. https://doi.org/10.1136/bmj.h6704 BMJ.
Smed S, Scarborough P, Rayner M, Jensen JD. The effects of the Danish saturated fat tax on food and nutrient intake and modelled health outcomes: an econometric and comparative risk assessment evaluation. Eur J Clin Nutr. 2016;70(6):681–6. https://doi.org/10.1038/ejcn.2016.6.
Bodker M, Pisinger C, Toft U, Jorgensen T. The Danish fat tax-effects on consumption patterns and risk of ischaemic heart disease. Prev Med. 2015;77:200–3. https://doi.org/10.1016/j.ypmed.2015.03.031.
Bíró A. Did the junk food tax make the Hungarians eat healthier? Food Policy. 2015;54:107–15.
Martos E, Bakacs M, Joó T, Kaposvári C, Nagy B, Nagy E et al. Assessment of the impact of a public health product tax. Budapest2015.
Hernandez FM, Batis C, Rivera JA, Colchero MA. Reduction in purchases of energy-dense nutrient-poor foods in Mexico associated with the introduction of a tax in 2014. Prev Med. 2019;118:16–22. https://doi.org/10.1016/j.ypmed.2018.09.019.
Taillie LS, Rivera JA, Popkin BM, Batis C. Do high vs. low purchasers respond differently to a nonessential energy-dense food tax? Two-year evaluation of Mexico's 8% nonessential food tax. Prev Med. 2017;105s:S37–s42. https://doi.org/10.1016/j.ypmed.2017.07.009.
Ng SW, Rivera JA, Popkin BM, Colchero MA. Did high sugar-sweetened beverage purchasers respond differently to the excise tax on sugar-sweetened beverages in Mexico? Public Health Nutr. 2018:1–7. https://doi.org/10.1017/s136898001800321x.
Fisher M, Baum F, MacDougall C, Newman L, McDermott D. A qualitative methodological framework to assess uptake of evidence on social determinants of health in health policy. Evidence & Policy: A Journal of Research, Debate and Practice. 2015;11(4):491–507. https://doi.org/10.1332/174426414X14170264741073.
Global Database on on the Implementation of Nutrition Action (GINA). World Health Organization. 2012. https://www.who.int/nutrition/gina/en/. Accessed April 2019 2019.
Healthy Eating-Healthy Action: Oranga Kai-Oranga Pumau: A Strategic Framework. Wellington, New Zealand. 2003.
Sérgio A, Correia F, Breda J, Medina J, Carvalheiro M, de Almeida M et al. National programme against obesity. Lisbon. 2005.
Zakotnik JM, Hlastan-Ribič C, Poličnik R, Pavčič M, Štern B, Pokorn D. Food and nutrition action plan for Slovenia 2005–2010. Ministry of health. 2007.
Estrategia NAOS. Spanish strategy for nutrition, physical activity and prevention of obesity. Madrid: Agencia Espanola de Seguridad Alimentaria; 2005.
Health, food and physical activity: Nordic Plan of Action on better health and quality of life through diet and physical activity. Copenhagen. 2006.
Healthy Weight 2008: Australia's Future: the National Action Agenda for Children and Young People and Their Families. National Obesity Taskforce Secretariat, Department of Health and Ageing. 2003.
Health Behaviors: promoting physical activity, prevention and treatment of obesity, healthful nutrition. Jerusalem, Israel. 2011.
French National Nutrition and Health Programs 2011–2015. 2011.
A fitter future for all: Framework for Preventing and Addressing Overweight and Obesity in Northern Ireland 2012–2022. 2012.
INFORM. German national initiative to promote healthy diets and physical activity. The National Action Plan for the Prevention of Poor Dietary Habits, Lack of Physical Activity, Overweight and Related Diseases Federal Ministry of Food, Agriculture and Consumer Protection & Federal Ministry of Health, Berlin. 2008.
Food Safety and Nutrition Strategy for 2014–2020. Czech Republic. 2014.
A Healthy Weight for Ireland: Obesity Policy and Action Plan: 2016–2025. Ireland: Department of Health. 2016. Report No.: 1406429260.
Norwegian National Action Plan for a Healthier Diet – an outline. Healthy diet, meal enjoyment and good health for everyone! 2017.
Switzerland; Eating Well and Staying Healthy: Swiss Nutrition Policy 2017-2024. 2017.
Strategy for food, meals and health. 2018.
The Nursery Milk Scheme. Department of Health. Updated 2019. https://www.nurserymilk.co.uk/about-nursery-milk-scheme. Accessed 06/11/2019.
Szpakowicz D. The healthy START scheme: an evidence review. Scotland. 2016.
•• Childhood obesity: a plan for action (Chapter 2). Department of Health and Social Care: Global Public Health Directorate: Obesity, Food and Nutrition. HM Government. United Kingdom. 2018. This policy document proposes similar food pricing policy actions to the Scottish plan, with the additional description of how revenue from an SSB tax can fund school meral programs in disadvantaged communities.
Food Policy for Canada. Canada.2019.
The World Bank. World Bank Country and Lending Groups (country classification). [Acccessed 31/07/19] Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519
Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27(2):237–46. https://doi.org/10.1177/1098214005283748.
•• A Healthier Future - Scotland's Diet & Healthy Weight Delivery Plan. The Scottish Government. Edinburgh. 2018. This policy document demonstrates a step towards comprehensive and strategic consideration of food pricing policy actions: including fiscal measures, price promotion restrictions, food vouchers and subsidised school meal programs.
Wilkinson R, Marmot M. Social determinants of health: the solid facts. Geneva: World Health Organization, Centre for Urban Health; 1998.
Palermo C. The cost of nutritious food: a determinant of health. Nutrition & Dietetics: The Journal of the Dietitians Association of Australia. 2011;4:246.
Using price policies to promote healthier diets. World Health Organization. 2015.
Eyles H, Ni Mhurchu C, Nghiem N, Blakely T. Food pricing strategies, population diets, and non-communicable disease: a systematic review of simulation studies. PLoS Medicine. 2012;9(12):e1001353–e. https://doi.org/10.1371/journal.pmed.1001353.
Kingdon J. Agendas. Alternatives, and public policies. Boston, MA: Longman. 2011.
Friel S, Hattersley L, Ford L, O'Rourke K. Addressing inequities in healthy eating. Health Promot Int. 2015;30(Suppl 2):ii77–88. https://doi.org/10.1093/heapro/dav073.
Pechey R, Monsivais P. Socioeconomic inequalities in the healthiness of food choices: exploring the contributions of food expenditures. Prev Med. 2016;88:203–9. https://doi.org/10.1016/j.ypmed.2016.04.012.
Bennett R, Zorbas C, Huse O, Peeters A, Cameron A, Sacks G, et al. Prevalence of healthy and unhealthy food and beverage price promotions and their influence on consumer purchasing behaviour– a systematic review of the literature. Obes Rev. 2019.
Zorbas C, Gilham B, Boelsen-Robinson T, Blake M, Peeters A, Cameron A, et al. The frequency and magnitude of price promoted beverages available for sale in Australian supermarkets. Aust N Z Public Health. 2019.
Riesenberg DBK, Zorbas C, Sacks G, Paix A, Marshall J, Blake MR, et al. Price promotions by food category and product healthiness in an Australian supermarket chain, 2017-2018. Am J Public Health:2019.
Penalvo JL, Cudhea F, Micha R, Rehm CD, Afshin A, Whitsel L, et al. The potential impact of food taxes and subsidies on cardiovascular disease and diabetes burden and disparities in the United States. BMC Med. 2017;15(1):208. https://doi.org/10.1186/s12916-017-0971-9.
Ball K, McNaughton SA, Le HND, Gold L, Ni Mhurchu C, Abbott G, et al. Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the supermarket healthy eating for life randomized controlled trial. Am J Clin Nutr. 2015;101(5):1055–64. https://doi.org/10.3945/ajcn.114.096735.
Brimblecombe J, Ferguson M, Chatfield MD, Liberato SC, Gunther A, Ball K, et al. Effect of a price discount and consumer education strategy on food and beverage purchases in remote indigenous Australia: a stepped-wedge randomised controlled trial. Lancet Public Health. 2017;2(2):e82–95. https://doi.org/10.1016/S2468-2667(16)30043-3.
Ratcliffe C, McKernan S-M, Zhang S. How much does the supplemental nutrition assistance program reduce food insecurity? Am J Agric Econ. 2011;93(4):1082–98. https://doi.org/10.1093/ajae/aar026.
Andreyeva T, Tripp AS, Schwartz MB. Dietary quality of Americans by supplemental nutrition assistance program participation status: a systematic review. Am J Prev Med. 2015;49(4):594–604. https://doi.org/10.1016/j.amepre.2015.04.035.
Whiteman ED, Chrisinger BW, Hillier A. Diet quality over the monthly supplemental nutrition assistance program cycle. Am J Prev Med. 2018;55(2):205–12. https://doi.org/10.1016/j.amepre.2018.04.027.
Hudak KM, Racine EF. The supplemental nutrition assistance program and child weight status: a review. Am J Prev Med. 2019;56(6):882–93. https://doi.org/10.1016/j.amepre.2019.01.006.
Lal A, Mantilla-Herrera AM, Veerman L, Backholer K, Sacks G, Moodie M, et al. Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: a cost-effectiveness and equity analysis. PLoS Med. 2017;14(6):e1002326. https://doi.org/10.1371/journal.pmed.1002326.
Baum F. From Norm to Eric: avoiding lifestyle drift in Australian health policy. 2011;35(5):404–6. https://doi.org/10.1111/j.1753-6405.2011.00756.x.
Carey G, Malbon E, Crammond B, Pescud M, Baker P. Can the sociology of social problems help us to understand and manage ‘lifestyle drift’? Health Promot Int. 2016;32(4):755–61. https://doi.org/10.1093/heapro/dav116.
Baker P, Hawkes C, Wingrove K, Demaio AR, Parkhurst J, Thow AM, et al. What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations decade of action on nutrition. BMJ Glob Health. 2018;3(1):e000485. https://doi.org/10.1136/bmjgh-2017-000485.
Backholer K, Beauchamp A, Ball K, Turrell G, Martin J, Woods J, et al. A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight. Am J Public Health. 2014;104(10):e43–50. https://doi.org/10.2105/AJPH.2014.302066.
Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health. 2018;18(1):869. https://doi.org/10.1186/s12889-018-5677-1.
Swartz H. Produce Rx programs for diet-based chronic disease prevention. AMA J Ethics. 2018;20(10):E960–73. https://doi.org/10.1001/amajethics.2018.960.
Conklin AI, Daoud A, Shimkhada R, Ponce NA. The impact of rising food prices on obesity in women: a longitudinal analysis of 31 low-income and middle-income countries from 2000 to 2014. Int J Obes. 2019;43(4):774–81. https://doi.org/10.1038/s41366-018-0178-y.
Temple NJ, Steyn NP. The cost of a healthy diet: A South African perspective. Nutrition. 2011;27(5):505–8. https://doi.org/10.1016/j.nut.2010.09.005.
Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global Syndemic of obesity, Undernutrition, and climate change: the lancet commission report. Lancet. 2019. https://doi.org/10.1016/s0140-6736(18)32822-8.
CZ was supported by an Australian Government and Research Training Scholarship. LGD was supported by an NHMRC Grant-funded Scholarship. KB was supported by a Heart Foundation Future Leader Fellowship (102047).
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Zorbas, C., Grigsby-Duffy, L. & Backholer, K. Getting the Price Right: How Nutrition and Obesity Prevention Strategies Address Food and Beverage Pricing Within High-Income Countries. Curr Nutr Rep 9, 42–53 (2020). https://doi.org/10.1007/s13668-020-00300-w
- Food price
- Food policy
- Fiscal policy
- NCD prevention
- Obesity prevention