Food price policies improve diet quality while increasing socioeconomic inequalities in nutrition

International Journal of Behavioral Nutrition and Physical Activity

Bernard Ruffieux²  Laurent Muller²  Anne Lacroix²  Nicole Darmon¹ 

[1]INSERM, NORT UMR1062, F-13385 Marseille, France

[2]Univ. Grenoble Alpes, GAEL UMR 1215, F-38000 Grenoble, France

关键词: Poverty;    Food choices;    Nutritional quality;    Nutrition policy;    Experimental economics;   

Others  :  803483
DOI  :  10.1186/1479-5868-11-66

 received in 2013-07-08, accepted in 2014-04-16,  发布年份 2014

【 摘 要 】

Background

Prices are an important determinant of food choices. Consequently, food price policies (subsidies and/or taxes) are proposed to improve the nutritional quality of diets. The aim of the present study was to explore the impact of food price policies on the expenditures and nutritional quality of the food baskets chosen by low- and medium-income households.

Methods

Experimental economics was used to examine two price manipulations: i) a fruit and vegetable price subsidy named “fruit and vegetables condition”; ii) a healthy-product subsidy coupled with an unhealthy-product tax named “nutrient profile condition”. The nutrient profiling system called SAIN,LIM was used. This system classifies each individual food according to its overall nutritional quality which then allows for a food item to be taxed or subsidized. Women from low- (n = 95) and medium-incomes (n = 33) selected a daily food basket, first, at current prices and then at manipulated prices. The redistributive effects of experimental conditions were assessed by comparing the extent of savings induced by subsidies and of costs generated by the tax on the two income groups. Energy density (kcal/100 g), free sugars (% energy) and the mean adequacy ratio (MAR) were used as nutritional quality indicators.

Results

At baseline (before price manipulations), low-income women selected less expensive and less healthy baskets than medium-income ones. After price manipulations expenditures for both income group decreased significantly, whereas, the nutritional quality improved (energy density decreased, the MAR increased). Additionally, the redistributive effects were less favourable for low-income women and their nutritional quality improvements from baseline were significantly lower.

Conclusion

Low-income women derived fewer financial and nutritional benefits from implemented food subsidies and taxes than medium-income women. This outcome suggests that food price policies may improve diet quality while increasing socio-economic inequalities in nutrition.

【 授权许可】

   
2014 Darmon et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organization: Diet, Nutrition and the Prevention of Chronic Diseases. Geneva: WHO Technical Report Series 916; 2003.
• [2]Communities of the European Communities: White Paper on a Strategy for Europe on Nutrition, Overweight- and Obesity-Related Health Issues. Brussels: Commission of the European Communities; 2007. http://ec.europa.eu/health/ph_determinants/life_style/nutrition/documents/nutrition_wp_en.pdf webcite
• [3]Lennernas M, Fjellstrom C, Becker W, Giachetti I, Schmitt A, de Winter Remaut A, Kearney M: Influences on food choice perceived to be important by nationally- representative samples of adults in the European Union. Eur J Clin Nutr 1997, 51:S8-S15.
• [4]Darmon N, Drewnowski A: Does social class predict diet quality? Am J Clin Nutr 2008, 87(5):1107-1117.
• [5]Drewnowski A, Darmon N: Food choices and diet costs: an economic analysis. J Nutr 2005, 135:900-904.
• [6]Darmon N, Bocquier A, Vieux F, Caillavet F: L’insécurité alimentaire pour raisons financières en France. In Les travaux de l'Observatoire national de la pauvreté et de l’exclusion sociale 2009-2010. Paris: La Documentation française; 2010:583-603.
• [7]Darmon N, Ferguson E, Briend A: A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming. J Nutr 2002, 132(12):3764-3771.
• [8]Maillot M, Darmon N, Darmon M, Lafay L, Drewnowski A: Nutrient-Dense Food Groups have high energy costs: an econometric approach to nutrient profiling. J Nutr 2007, 137(July):1815-1820.
• [9]Lustig RH, Schmidt LA, Brindis CD: The toxic truth about sugar. Nature 2012, 482:27-29.
• [10]Faulkner G, Grootendorst P, Nguyen V, Andreyeva T, Arbour-Nicitopoulos K, Auld M, Cash S, Cawley J, Donnelly P, Drewnowski A, Dube L, Ferrence R, Janssen I, LaFrance J, Lakdawalla D, Mendelsen R, Powell L, Traill WB, Windmeijer F: Economic instruments for obesity prevention: results of a scoping review and modified delphi survey. Int J Behav Nutr Phys Act 2011, 8(1):109. BioMed Central Full Text
• [11]Wall J, Mhurchu CN, Blakely T, Rodgers A, Wilton J: Effectiveness of monetary incentives in modifying dietary behavior: a review of randomized. Controlled Trials Nutr Rev 2006, 64(12):518-531.
• [12]Andreyeva T, Long M, Brownell K: The impact of food prices onconsumption: a systematic review of research on the price elasticity ofdemand for food. Am J Public Health 2010, 100(2):216-222.
• [13]Mytton O, Gray A, Rayner M, Rutter H: Could targeted food taxes improve health? J Epidemiol Community Health 2007, 61(8):689-694.
• [14]Schroeter C, Lusk J, Tyner W: Determining the impact of food price and income changes on body weight. J Health Econ 2008, 27(1):45-68.
• [15]Smed S, Jensen JD, Denver S: Socio-economic characteristics and the effect of taxation as a health policy instrument. Food Policy 2007, 32(5–6):624-639.
• [16]Dallongeville J, Dauchet L, de Mouzon O, Réquillart V, Soler L-G: Increasing fruit and vegetable consumption: a cost-effectiveness analysis of public policies. Eur J Pub Health 2011, 21(1):69-73.
• [17]Epstein LH, Jankowiak N, Nederkoorn C, Raynor HA, French SA, Finkelstein E: Experimental research on the relation between food price changes and food-purchasing patterns: a targeted review. Am J Clin Nutr 2012, 95:789-809.
• [18]French S: Pricing effects on food choices. J Nutr 2003, 133:841S-843S.
• [19]Harnack L, French S, Oakes J, Story M, Jeffery R, Rydell S: Effects of calorie labeling and value size pricing on fast food meal choices: results from an experimental trial. Int J Behav Nutr Phys Act 2008, 5(63):5.
• [20]Carlsson F: Non-market valuation: stated preferences method. In The Oxford Handbook of the Economics of Food Consumption and Policy. Edited by Lusk JL, Roosen J, Shogren J. Oxford: Oxford University Press; 2011:181-214.
• [21]Davis DD, Holt CA: Experimental Economics. Princeton: Princeton University Press; 1993.
• [22]Friedman D, Sunder S: Experimental Methods: A Primer for Economists. New-York: Cambridge University Press; 1994.
• [23]Kagel JH, Roth AE: The Handbook of Experimental Economics. Princeton: Princeton University Press; 1995.
• [24]Camerer CF, Hogarth RM: The effects of financial incentives in experiments: a review and capital-labor-production framework. J Risk Uncertain 1999, 19(1):7-42.
• [25]Alfnes F, Rickertsen K: Non-market evaluation: experimental methods. In The Oxford Handbook of the Economics of Food Consumption and Policy. Edited by Lusk JL, Roosen J, Shogren JF. New York: Oxford Press University; 2011:215-242.
• [26]World Health Organization: Nutrient Profiling: Report of a WHO/IASO Technical Meeting (London, United Kingdom, 4-6 October 2010). http://www.nutrinfo.com/biblioteca/libros_digitales/nuyrient.pdf webcite
• [27]INSERM: Su-Vi-Max: Table de composition des aliments. Paris: Economica; 2006.
• [28]Medical Expert Systems http://www.mxs.fr/index/accueil webcite
• [29]Darmon N, Vieux F, Maillot M, Volatier JL, Martin A: Nutrient profiles discriminate foods according to their contribution to nutritionally adequate diets: a validation study using linear programming and the SAIN, LIM system. Am J Clin Nutr 2009, 89(4):1227-1236.
• [30]Maillot M, Drewnowski A, Vieux F, Darmon N: Quantifying the contribution of foods with unfavourable nutrient profiles to nutritionally adequate diets. Br J Nutr 2011, 105:1133-1137.
• [31]Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC, Rolls BJ: Low-energy-density diets are associated with high diet quality in adults in the United States. J Am Diet Assoc 2006, 106(8):1172-1180.
• [32]Schroder H, Vila J, Marrugat J, Covas M: Low energy density diets are associated with favorable nutrient intake profile and adequacy in free-living elderly men and women. J Nutr 2008, 138(8):1476-1481.
• [33]Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC, Rolls BJ: Dietary energy density determined by eight calculation methods in a nationally representative United States population. J Nutr 2005, 135(2):273-278.
• [34]WCRF-AICR: Food, nutrition physical activity and the prevention of cancer: a global perspective. Washington: World Cancer Research Fund/American Institute of Cancer Research; 2007.
• [35]Dubois L, Girard M, Bergeron N: The choice of a diet quality indicator to evaluate the nutritional health of populations. Public Health Nutr 2000, 3(3):357-365.
• [36]Krebs-Smith SM, Smiciklas-Wright H, Guthrie HA, Krebs-Smith J: The effects of variety in food choices on dietary quality. J Am Diet Assoc 1987, 87(7):897-903.
• [37]Ries CP, Deahler JL: Evaluation of the Nutrient Guide as a dietary assessment tool. J Am Diet Assoc 1986, 86(2):228-233.
• [38]Ferland S, O'Brien HT: Maternal dietary intake and pregnancy outcome. J Reprod Med 2003, 48(2):86-94.
• [39]Keller HH, Ostbye T, Bright-See E: Predictors of dietary intake in Ontario seniors. C J Public Health 1997, 88(5):305-309.
• [40]Guthrie HA, Scheer JC: Validity of a dietary score for assessing nutrient adequacy. J Am Diet Assoc 1981, 78(3):240-245.
• [41]Darmon N, Darmon M, Maillot M, Drewnowski A: A nutrient density standard for vegetables and fruits: nutrients per calorie and nutrients per unit cost. J Am Diet Assoc 2005, 105(8):1881-1887.
• [42]Cutler DM, Glaeser EL, Shapiro JM: Why have Americans become more obese? J Econ Perspect 2003, 17(3):93-118.
• [43]Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Löwik MR: Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey. Eur J Clin Nutr 2003, 57:128-137.
• [44]Irala-Estevez JD, Groth M, Johansson L, Oltersdorf U, Prattala R, Martinez-Gonzalez MA: A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables. Eur J Clin Nutr 2000, 54(9):706-714.
• [45]Kirkpatrick S, Tarasuk V: The relationship between low income and household food expenditure patterns in Canada. Public Health Nutr 2003, 6(6):589-597.
• [46]Shahar D, Shai I, Vardi H, Shahar A, Fraser D: Diet and eating habits in high and low socioeconomic groups. Nutrition 2005, 21:559-566.
• [47]Williams RA, Roe LS, Rolls BJ: Comparison of three methods to reduce energy density. Effects on daily energy intake. Appetite 2013, 66:75-83.
• [48]Marti-Henneberg C, Capdevila F, Arija V, Perez S, Cuco G, Vizmanos B, Fernandez-Ballart J: Energy density of the diet, food volume and energy intake by age and sex in a healthy population. Eur J Clin Nutr 1999, 53(6):421-428.
• [49]Stubbs J, Ferres S, Horgan G: Energy density of foods: effects on energy intake. Crit Rev Food Sci Nutr 2000, 40(6):481-515.
• [50]Hamelin AM, Beaudry M, Habicht JP: Characterization of household food insecurity in Quebec: food hands feelings. Soc Sci Med 2002, 54:119-32.
• [51]Caillavet F, Lecogne C, Nichèle V: La consommation alimentaire: des inégalités persistantes mais qui se réduisent. In Cinquante ans de consommation en France - Édition 2009. Edited by INSEE. Paris: INSEE; 2009:49-62.
• [52]Allais O, Bertail P, Nichèle V: The effects of a fat tax on french households’ purchases: a nutritional approach. Am J Agric Econ 2010, 92(1):228-245.
• [53]Caraher M, Cowburn G: Taxing food: implications for public health nutrition. Public Health Nutr 2005, 8(8):1242-1249.
• [54]Chouinard HH, Davis DE, LaFrance JT, Perloff JM: Fat taxes: big money for small change. Forum Health Econ Policy 2007, 10(2):Article 2.
• [55]Kuchler F, Tegene A, Harris JM: Taxing snack foods: manipulating diet quality or financing information programs? Rev Agric Econ 2005, 27(1):4-20.
• [56]Jensen JD, Smed S: Cost-effective design of economic instruments in nutrition policy. Int J Behav Nutr Phy 2007, 4(10):4-10.
• [57]Nnoaham K, Sacks G, Rayner M, Mytton O, Gray A: Modelling income group differences in the health and economic impacts of targeted food taxes and subsidies. Int J Epidiemol 2009, 38(5):1324-1333.
• [58]Thow A, Jan S, Leeder S, Swinburn B: The effect of fiscal policy on diet, obesity and chronic disease: a systematic review. Bull World Health Organ 2010, 88:609-614.
• [59]Nordstrom J, Thunstrom L: Can targeted food taxes and subsidies improve the diet? Distributional effects among income groups. Food Policy 2011, 36:259-271.
• [60]Zhen C, Finkelstein EA, Nonnemaker JM, Karns SA, Todd JE: Predicting the effects of sugar-sweetened beverage taxes on food and beverage demand in a large demand system. Am J Agric Econ 2014, 96(1):1-25.
• [61]Frohlich KL, Potvin L: The inequality paradox: the population approach and vulnerable populations. Am J Public Health 2008, 98(2):216-221.
• [62]Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemström Ö, Valkonen T, Kunst AE: Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol 2003, 32(5):830-837.
• [63]Leclerc A, Chastang J-F, Menvielle G, Luce D: Socioeconomic inequalities in premature mortality in France: have they widened in recent decades? Soc Sci Med 2006, 62(8):2035-2045.