Measuring the cost of diets can help people make healthier food choices
Gretchen Miller: Hello there, Gretchen Miller joining you as we kick off our sixth year of Prevention Works. Isn’t that remarkable? So, hats off to The Australian Prevention Partnership Centre for its commitment to relatable and engaging conversations around the best research that addresses the pernicious issue of chronic disease.
I’m having a proud moment today for the longevity of this series and very much want to thank Ainsley Burgess and Helen Signy, who have always been the backseat drivers here from the Prevention Centre. They choose all the fascinating people we talk with and are dedicated to communicating this work.
Our guest today is another great research story. Dr Meron Lewis executed quite the career change from defending intellectual property as a patent attorney. She became determined to do grounded work on dietetics, less the blood tests and nutrients and more the why we keep choosing discretionary, poor for your health food, even when we can’t afford it.
Dr Lewis realised how research could help people make healthy food choices in their everyday lives. And she’s now a Research Fellow with the University of Queensland’s Food Pricing Research Team in the School of Public Health.
Her work has supported the development and implementation of the Healthy Diets ASAP protocols with Professor Amanda Lee, who was one of Prevention Works first interviewees. We’ll talk a bit more about that later in the program. And it’s been utilised by the Queensland Council of Social Services as it prepares household budget standards.
And the Prevention Centre has supported this research and other work Meron has been involved in. She’s passionate about social justice and a driving force for her is how research, which can seem pretty isolated up there in academia and in journal articles, can make a real difference in helping people make the right daily food choices on the ground. Meron, welcome. First up, would you speak to that grounded nature of your work?
Meron Lewis: I think it’s important in the work that we do that there’s always a practical aspect to it. I’ve heard some people talk about it being a pracademic, but yeah, it’s always having a focus on what you’re trying to do, why are you trying to do it, what benefit can you give to the people particularly the people who really need it. So yeah, always trying to keep the people in the focus of the research and why you’re doing it.
Gretchen: I guess you have to think about that person who’s walking into the shops to make the choices that they make, and what’s influencing those choices, not only in the supermarket itself, but outside what brings them in there, how they’re feeling at the time, you know, and how they make those choices according, in fact, to how they’re feeling at the time? [00:03:06]
Meron: That’s right. And that’s one of the things that got me into nutrition in the beginning was, you know, you’re in the supermarket, you’re filling your trolley and then you’re standing at the checkout. You know, daydreaming away and you can’t help, but just look at what other people have got in their trolley, and you’re sort of thinking, why are they buying that? And yeah, that’s one of the things that got me interested in this sort of field of food retail and nutrition is, why are they choosing that and I’m choosing this?
Gretchen: Oh, super interesting way to actually think about it you know, when you’re actually in there on that cold lino floor. The field wasn’t always your arena though, Meron. I wonder what brought you here as a mature age student? I mean, you’ve done several degrees in it since, but what was it that made you do that abrupt about face?
Meron: Yes, it was fairly abrupt in a way. Well, I was working as a patents and trademarks attorney and…
Gretchen: …I imagine that’s quite a high-flying job, right?
[00:04:04] Meron: I don’t know about high flying, it’s lots of suits and an office environment but it is very business focused, very much about protecting your business and money and charging out at hourly rates, all of that sort of emphasis, and protecting your business assets. And yes, for me, I was sort of going through a bit of a midlife crisis in a way, with a marriage breaking down and just reassessing my whole world and thinking to myself, this is not really aligning with my values. I want to be more about the people and less about the money. I’m not very focused on money and making money and making other people money. I wanted to help people and be more focused on the people. And that combined with liking food, it just made me think nutrition.
Gretchen: So, you were a single parent and then a carer and you are working in health research, so you know firsthand what it’s like to be juggling both time and money? I wonder if you could talk to that lived experience as you made food choices for your family. And I think for a while there you were on the single parent pension, Newstart?
Meron: Yeah, that’s right. When I made the decision to go back to uni I had two primary school aged children, one with special needs, and that was another reason for going back to uni, was to have a little bit more time and flexibility to look after the kids, because I had them but it did require me to go on to the single parent pension to fund going through all that.
And so, I’m sitting there at uni learning about all the food that you should be buying, and you should be eating and then coming home and going to the shops. I think back then I had a budget of $160 a week for everything, which was achievable with what I had, and I was able to get some child support as well, but you really had to just be a lot more careful and watch it. And I remember thinking, for people who didn’t have child support or didn’t have the surrounding things that I had and the education that I had, how would they manage to be able to buy the healthy food?
Gretchen: Were you ever tempted, you know, under pressure to choose the wrong foods. Like, did you just go, “Oh, just really hungry right now. I’m going to buy that bag of chips?”
[00:06:36] Meron: Yeah, absolutely. I mean, the kids would be wanting the things, you know, that’s what little kids do, they see things in the environment. I picked them up from school and across the road from school is a bakery and so, they’d want to get something from the bakery. So, you know, we had to set up, I think it was Monday Bunday, we used to have [laughter] where on Mondays are allowed to get a finger bun or something from the bakery which meant that the rest of the week the answer was always going to be no, because, well, you got one on Monday.
Gretchen: I love that. It is just so interesting to talk and think about it, knowing that you’ve gone through all of this yourself. Food insecurity kind of comes into this as well, I think. And we’ve talked about food insecurity on Aboriginal lands before on Prevention Works, and even peri-urban communities struggling with that issue. So, I wonder if we could go back to that work I mentioned in the introduction on the Healthy Diets ASAP protocol? You helped modify that protocol for remote Aboriginal communities, what did that work look like?
[00:07:38] Meron: Well, that work came out of some remote communities in Central Australia who were wanting to look at their food environment, including cost, because a lot of people were doing it really tough. Incomes are pretty low and there’s only one store to go to in each community, and so they were wanting to monitor and measure how much food was going to cost them in that community compared to if they travelled several hours down the road to Alice Springs.
Professor Amanda Lee had done the original development of the Healthy Diets ASAP, which is Australian Standardised Affordability and Pricing Protocol. So, we wanted to modify that to more closely align with the dietary intakes and experiences of Aboriginal and Torres Strait Islander peoples.
The Healthy Diets ASAP has two aspects where it measures the cost of what we call a habitual diet, which is based on what people report they actually eat and then we also cost what we call the healthy or recommended diet, which is based on the Australian Dietary Guidelines. So, you’ve got how much for people paying for what they say they eat and how much would they need to pay for what they should be eating.
So that’s the sort of two main diets we cost for Healthy Diets ASAP.
And so we modified the habitual diet based on reported intakes from the National Aboriginal and Torres Strait Islander Nutrition Survey so it’s based on what Aboriginal and Torres Strait Islander people said they were eating. So yes, we just modified the intakes to match that, and used that to measure the cost of the habitual diet and healthy diet in those remote communities.
We also measure affordability. So, in those communities we were calculating incomes based on either a minimum wage income for the household or a welfare dependent income. So, then you are able to see what age of that household income do people need, and then that can expose that food insecurity problem. You know, when you’re able to say, “Look, it’s going to cost people 40, 50% of their total income to buy a healthy diet.” You can see why that is a real challenge!
Gretchen: And as we discussed earlier that’s a challenge that you have actually lived yourself and then Queensland Council of Social Services used the same protocol to advocate for welfare and minimum wage incomes. So that’s really interesting, obviously. I’m not sure whether that work was actually directly connected, or it’s all part of the same spectrum of affordability and availability?
[00:10:24] Meron: It’s similar, the Queensland Council of Social (QCOSS) were looking at another modification we did of Healthy Diets ASAP, which was directed at low socioeconomic groups. So, for that particular version, we based the habitual diet on reported intakes of the lowest 20% of income households. So those low-income households reported what they ate and we used that to build the habitual diet and costed that. The recommended diets are obviously the same for everybody. But we also collected the prices of two different sets of products. Firstly, the sort of common, typical brands that most popular people buy and then we also costed of the diets using the cheapest available equivalent. So that’s those generic brands, those cheaper brands, which is a strategy that people are using when they don’t have a huge amount of money.
By using those two costing profiles, we got two costs of the recommended diet, which is what QCOSS were interested in. When you cost it using the cheapest items, it’s about 30-31% cheaper but of course, people are not always going to be constantly buying the generic items because people have different tastes. There can be a bit of stigma still around buying generic items all the time. So, we took a halfway point between all the branded products and all the generic products and that’s what QCOSS used when they were developing household budgets. So, they developed a budget which included housing, food, transport, fuel – all the different things that people would buy. And so, they used our methods of costing what a recommended healthy diet would cost because it’s then building in a quality measure of allowing the household…saying, this is what the household needs to buy, not just any food so they don’t starve, but actual healthy food so they can live and thrive. And they also applied that to their housing, where they were looking at rent for a house that not just had four walls and a roof, but had a working kitchen, a working bathroom, sufficient room for the household. So by building that quality in then they were able to develop household budgets which were actually supporting households to live and thrive, and then they could compare that to the welfare that particular household were eligible for and be able to look at the usually shortfall to enable them to advocate for increasing the welfare rates.
[00:13:02] Gretchen: And I think the research that you’ve done puts figures out there that I haven’t been particularly aware of. I mean, you often hear about rent as a proportion of income, but you rarely hear about food costs as a proportion of income and you compared the proportion of income it takes to achieve a healthy diet and I wondered if you could run some of those statistics by us, as you outlined them in a letter to the editor of the ANZ Journal Of Public Health?
Meron: In housing, there’s this concept of housing stress where if you’re spending more than about a third of your income on housing, then you’re under housing stress. And a similar concept has been applied to food, where if you’re paying more than 30%, we say is unaffordable, between 25 and 30we say the households in food stress. That’s another concept that’s been floated. So, it’s kind of a line in the sand that we can use to compare, and when we’ve costed diets across in various locations in Australia in major cities and in remote locations, then we’re often finding that the welfare dependent households are paying 35-40% of their income to buy a healthy diet, and then in those remote communities it’s up to 40 or 50%.
[00:14:22] Gretchen: Because what you’ve got in remote communities is a low income and way more expensive food, shockingly expensive.
Meron: Yeah, there’s much more expensive food and then usually people are on much lower incomes. So, it just all gets worse. We did one study where we looked across Queensland in major cities, inner regional, outer regional and remote communities, and we looked at different socioeconomic disadvantage of the places we went to and found that the socioeconomic disadvantage level, as determined by the ABS, didn’t make much difference to the cost of food, but remoteness just sent it skyrocketing up.
[00:15:02] Gretchen: And then, I think you wrote that article during lockdown, the most intense period of COVID, when food costs actually jumped quite significantly. But at the same time, we had emergency government benefits that actually helped a lot of low-income families live more healthily than they had been at least in the year or two prior?
[00:15:24] Meron: That’s right. COVID first came along in 2020 and a lot of people were suddenly out of work. One good thing the government did was introduce this Coronavirus supplement. So, for various welfare payments, including JobSeeker, the amount of money that people got doubled pretty much. And for the first time we saw that the cost of a healthy diet dropped below that 25% stress mark and it became affordable.
The Australian Council of Social Services did a survey of people receiving JobSeeker and something like 80-85% of them said that they were able to afford healthy food for the first time. So, by giving people more money, they bought healthier food. So that’s one of the things we’re really trying to advocate for that, you know, food is this discretionary budget. You can’t change your rent very quickly, you can’t change your utilities very quickly, but if you get a big bill you can drop your food costs in the next few days and really reduce it.
So that’s what people tend to do when times get tough. They reduce their food budget to try and get through that immediate or even longer-term problem. That extra money really helped people to afford food but sadly that didn’t last. They reduced it, and reduced it, and reduced it, and then eventually it disappeared at the beginning of 2021.
And food prices, as you said, continued to rise as the cost-of-living crisis bit. And we were able to show, because we measured the cost of the healthy and the unhealthy habitual diets between 2021 and 2022, the cost of the healthy diet increased almost twice as much as the cost of the habitual diet. So that just puts even further pressure on people, in trying to afford healthy food.
Gretchen: And as we know that pressure has a long-term payout in terms of overall cost for, you know, health expenditure?
[00:17:26] Meron: That’s right. Health expenditure and for children’s development and wellbeing and school attendance and education and social inequality and employment. If you’re not getting enough of a good diet it affects your day-to-day life in the short term and the long term. You know, our rates of diabetes are increasing all the time, which is very diet related.
Gretchen: Okay, how are we tracking now when we look at these percentages? I mean, despite a recent increase in welfare payments, what’s been the impact there?
Meron: Yeah, back in September 2023, there was an increase in welfare payments which was the first major one in a while and so it was sort of exciting, you think, okay, finally people are going to get a bit more money and so we wanted to measure what impact that had on the affordability of the diets. But for most people, it really didn’t make that much difference, the increase just wasn’t enough to drop it below that 30 and 25%.
The only households that did have a little bit of a better time were single parent households with a child between the ages of 8 and 14, because it used to be when I was on the single parent pension, once the youngest child turned 8 you had to go to JobSeeker, which was a lower payment. They’ve now increased that age to 14, back to what it used to be and so the single parent family, which is one of the reference households I track, their payment increased quite a bit because they shifted onto the single parent payment. So that improved their affordability of food a bit better. But even so, all the households with children that I look at, they’re still finding it really tough to afford a healthy food unless they’re really buying the cheapest food all the time which is a real struggle to do for many people.
[00:19:18] Gretchen: And I read that in April 2023, 23 to 37% of the income of welfare dependent households with children was required to purchase recommended diets and the change when the welfare increases occurred in September 2023 was, now it’s 20 to 35%. So, you’ve got like a, a 2 to 3% difference and you’re really still talking about food stress. So, it’s insufficient in other words?
[00:19:47] Meron: It’s still insufficient and also when you consider that we have this line in the sand of 25 and 30%, but the way housing and fuel and utilities bills have gone up, that line in the sand of 25 to 30% is probably not realistic anymore. You hear reports of a lot of people paying more than 50% of their income in rent and that just puts all that more pressure. So, you know, even though it’s got a little bit better, it’s just not enough.
Gretchen: To change direction just a little bit before we close. Of course, the pressure is not just affordability, but it’s in, as you described earlier in the interview, this sort of social pressures that are involved as well. And the trick is that discretionary food manufacturers, which is basically a polite term for junk food, right, they’re a tricky target to work against? There’s a lot of counter research being done into attracting their market. I wonder if you could talk to some of the techniques you’ve observed that these families already under stress are experiencing as a pressure to buy that junk food?
[00:20:56] Meron: Well, that’s right, when we look at the habitual diet, which we also sometimes call the unhealthy diet (because that’s unfortunately what most people report eating) about 58 to 60% of the food budget is spent on those discretionary food and drinks. So that is junk food, ultra processed food discretionary food, whatever you like to call it, the stuff we shouldn’t be eating. And so, you think about, you know, 58 to 60% of the budget, that’s a lot of money that those food companies are getting from us and so that’s a lot of budgets that they have to do their marketing and promotion.
Some other colleagues have looked at promotion of food, that discretionary food is on special far more often, it’s promoted far more often, it’s put in the end of the aisles far more often than the healthy food is. And even when we look at the generic food items, while it’s great that the generic food items can give people a cheaper way to buy food, it’s the packaged items that are then coming down.
You don’t get generic apples, or generic broccoli, but you do get generic biscuits and generic cereals and so that can encourage people to keep buying these processed packaged foods because they look so much cheaper and perceived cost is a real factor.
We’ve shown that healthy diets are usually cheaper than unhealthy diets for most households but the perception out there is that healthy diets are expensive. And when you see generic branded packaged food, that also lasts longer and is more convenient, then that’s why people will tend to go for it. And I think that’s why we see that all that money going to the unhealthy food industries, which then has the money to then continue to market and promote and develop more and more foods. You know, as soon as there’s a new thing comes out, there’s new foods that appear.
[00:22:52] Gretchen: Yes, and then the kids want to try those new things when they see them in other people’s lunch boxes and so on…
Meron: Yes, or they get those ‘health halos’ where in more recent years there’s been a push for low sugar and, you know sugar is really the enemy. And then you’ll see all the packets come out with no cane sugar, no artificial sweeteners, but when you read the back there is still plenty of sugar, plus fat, and salt, all those things. So yeah, they market it and turn it around very quickly as new things.
Gretchen: Can you outline some of the changes to regulation that you’ve demonstrated will work to support people making healthier choices for themselves when they’re standing in that supermarket aisle, those real people that you’ve observed?
[00:23:38] Meron: Yeah, I mean there’s one factor that we do have already and that a lot of people are unaware of is the fact that our GST, the Goods and Services Tax, doesn’t apply to healthy basic food. Those healthy basic foods are exempt and so that’s one of the factors that helps make our healthy diets a bit cheaper than the unhealthy diet. So, if you’re looking at your supermarket docket, you’ll often see there’s a little mark next to all the ones you’ve bought that have got GST on, and we’ve shown by using our protocols as modelling that if that exemption was to be removed then the cost of healthy diets would go up a hell of a lot more than the cost of the unhealthy diets.
Every few years some bright spark says, oh, we should extend GST to everything, and we’ve had to fight that and say, no, no, no, no, no, we’ve got to keep it there for health and so far, we’ve been successful, but that’s one thing we really have to keep on top of and keep working on. There’s been some suggestions that increasing the GST, which would be an unpopular move I give you, it would make those unhealthy foods that bit more expensive which might nudge people towards the healthy foods. But yeah, GST, because of the way it’s applied can hit low-income people a lot harder so then that’s also another problem.
Gretchen: You’ve also made suggestion of financial subsidies along specific food supply chains?
[00:25:03] Meron: Yeah, particularly for the low-income people. In the US [United States] they have I think it’s called SNAP food vouchers, which have some successes and some challenges but that’s an option perhaps to give low-income people some more targeted money specifically for healthy foods.
In terms of supply, in our remote communities they have been calling for years and years and decades to have some subsidies or support around having the stores as an essential service that has to be provided and staffed all the time to help with the transport because some of them, you know, particularly in wet seasons, rely on planes or helicopters if the barges can’t get through if they’re on island property. So, we need those sorts of support to help those places where the cost of food is so much more and then of course there’s the advocacy for welfare payments for people in remote areas, there is a remote area allowance but it’s not very much, so there’s an opportunity to increase the money as well.
Gretchen: So, Meron, how long before these projects wrap up and where to next? I imagine in a way it’s an ongoing project?
[00:26:17] Meron: It’s very much an ongoing project, you know, you’ve got to keep monitoring and benchmarking. We showed when we collected the data over four years in Brisbane through COVID, we were able to see from 2021 to 2022, how the healthy food went up so much more and that was something that wasn’t really apparent, from CPI indexes for instance, and we want to keep going and keep monitoring it to keep up the pressure because the problems are not solved. So, we’ve got to keep going and doing it in different areas. You know, we’ve done it opportunistically here in Brisbane and a few other places with people have got students that need a project doing, but to measure the cost, you know, in Tasmania, I’m sure is very different to Darwin, which is very different to Perth, and Broome, and Sydney. So, measuring the cost in all the different places would really give a full and proper picture of how it goes. Because the welfare payments are the same whether you live in all those places but the cost of food is likely different. So that’s one area we need to go into.
Gretchen: I’m struggling to believe that we don’t know the cost of healthy diet around the country?
Meron: Yeah, surprising, isn’t it?
Gretchen: My goodness.
[00:27:29] Meron: I mean, as I said, we have CPI data, but that doesn’t look at a diet and looking at a diet for a household over a fortnight, your standard diet, that’s what affects their long-term health. So, CPI is more just a group of foods that people buy. So, yeah, it’s surprising that it hasn’t happened before, but yeah. we’re trying to get the funding to do it but we also want to look at more specific groups as well, international students, creating modified versions for refugees or recent immigrant people who have a lot of struggles with income as well and culturally appropriate food and another area we want to look at is sustainability. And, you know, climate change is one of the factors that’s making our food costs go up. A diet according to the dietary guidelines is produced with 25% less greenhouse gas emissions than the habitual unhealthy diet. So that’s, you know, if everyone switched to a healthy diet, we’d be better for the environment. It would be good to develop a healthy diet that has even more of a focus on environmental sustainability, so that we can see what more could be done and how much that would cost the ordinary people in the street to do that switch.
Gretchen: Because, without a shadow of a doubt, that’s something that we actually need to view most issues in our society through that lens, I think. Meron Lewis, it’s been so interesting to talk with you. Thank you so much for your time this morning. Really appreciate it.
Meron: Thanks Gretchen it was lovely talking to you.
[00:28:58] Gretchen: Dr Meron Lewis, there joining us on Prevention Works, a podcast of The Australian Prevention Partnership Centre. I’m Gretchen Miller and I’d love it if you could leave a review for us on Apple Podcasts, if you can. Until next time, bye for now.
[END 29:29]
Episode summary
A Research Fellow at the University of Queensland’s School of Public Health, Dr Meron Lewis research focuses on food price and affordability monitoring tools, protocols and methods, to help people make healthier food choices in their everyday lives.
Meron supported the development and implementation of the Healthy Diets Australian Standardised Affordability and Pricing (ASAP) protocol with Professor Amanda Lee. Healthy Diets ASAP measures the cost of a habitual diet, which is based on what people report they eat, and a healthy or recommended diet, which is based on the Australian Dietary Guidelines.
Associated content
Show notes
Find out more about:
- Dr Meron Lewis’ PhD project on assessing the cost of healthy diets in low socioeconomic groups in Australia.
- Professor Amanda Lee’s original work on the development of the Australian Standardised Affordability and Pricing Protocol (Healthy Diets ASAP)
- The Australian Government Department of Health and Aged Care Australian Dietary Guidelines.
- The National Aboriginal and Torres Strait Islander Nutrition Survey, conducted by the Australian Bureau of Statistics.