Technical Paper 1:
Obesity in Australia: a need for urgent action
4.3 - Food subsidies
The cost of food
There is increasing evidence that food is more costly in rural areas compared to metropolitan areas across Australia.[70-72] There is also increasing evidence that the availability, accessibility and costs of nutritious food influence consumers who are socially or geographically disadvantaged and their ability to consume healthy food. In the 1995 and 2001 NHS surveys, around 5% of adults reported that there had been times in the previous year when they had run out of food and could not afford to buy more. Australians at particular risk of food insecurity include older people, those living in rural and remote areas, and those with a disability. In 2006 a healthy food basket cost on average 29% more (ranging from 24% to 56%) in remote areas of the Northern Territory compared with Darwin.
The 2006 Queensland Healthy Food Access Basket Survey compared food price movements at 47 stores throughout the state between 2000 and 2006 for a standard basket of food containing such items as bread, cereals, fruit and vegetables, milk, steak, chicken, rice and pasta. Results revealed regional price differences: in Brisbane, the price of a fortnight’s groceries increased between 2000 and 2006 from $299 to $443 (48%); in regional Queensland, prices increased by 54% in Cairns, Townsville, Bowen, Emerald and Goondiwindi. The same basket of food cost up to $113 more in very remote areas of Queensland than in Brisbane. Price increases have been attributed to the drought, increasing costs of production and rising fuel prices.
A study in a remote Northern Territory Aboriginal community found that food in general cost 50% more than in Darwin, and that families spent an average of 38% of their income on food and non-alcoholic beverages, compared with 14% for the average Australian household and 30% for low-income non-remote Australian households.
At least 44% of household income and significant changes in purchasing patterns would be required to achieve dietary recommendations. While community members reported a preference for fresh produce, more than half the average energy intake in the community came from white bread and flour, sugar and milk powder, products that provide most calories for least cost, store well and divert hunger. However, when factors including store management and leadership, workforce development and improved infrastructure were addressed through a whole-of-store approach, sales of fruit and fresh vegetables increased. Thus, while still facing significant economic barriers, people in the community purchased more fruit and vegetables when given the opportunity.
Improving access to healthy foods in remote areas
Strategies that have been suggested to improve access to healthy foods among rural and remote Indigenous Australians include.
- The provision of vouchers to buy a weekly basket of nutritious foods.
- The examination of patterns of transport and marketing to reduce barriers to the trade of fresh local foods.
- The support of economic development opportunities such as agriculture and horticulture, and the development of traditional food resources.
- The provision of adequate remote food storage infrastructure.
- The development of the Indigenous workforce in remote and rural stores.
Evidence suggests that subsidising the transportation of healthy foods in remote regions is an effective means of promoting healthy eating; for example, an evaluation of the Canadian Food Mail Program, which subsidises the cost of transporting nutritious perishable foods to isolated communities, found that increasing the freight subsidy from 30 to 80 cents per kilogram for healthy products like fruits, vegetables and dairy as part of a pilot project in three communities resulted in a significant increase in the purchase of these products.
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While there is a need to ensure access to fresh produce in remote areas, it should be noted that the availability of healthy frozen and canned foods (such as ‘low salt’ or ’no added salt’ varieties of canned goods) is also important. These can provide convenient and economical access to fruit and vegetables for consumers. These foods can be as nutritious as fresh forms: frozen vegetables picked and frozen within hours of harvest, for example, may actually retain more nutrients than the unprocessed form. There is also a need to ensure that key messages around dietary guidelines (eg. the consumption of two servings of fruit and five servings of vegetables a day) include information about the range of ways in which these intake levels can be met, such as through the intake of canned or frozen foods.
However, frozen vegetables require freezer transport, which is likely to be more expensive than chilled freight for fresh fruit and vegetables and unchilled freight for canned goods/non perishables. In addition, remote community household infrastructure may not support measures to improve access to healthier food, be it fresh or frozen. For example, evidence indicates that in the Northern Territory less than half of houses surveyed in remote communities had a functioning fridge, while only 6% of 4343 houses in Aboriginal communities across Australia assessed between 1999 and 2006 had functional nutritional hardware (storage space for food, preparation, functional stove and sink).
To address this lack of basic amenities, other initiatives may be appropriate and more urgent, such as subsidies for refrigerators or other infrastructure in remote communities for better storage of fruit and vegetables; or schemes to improve household infrastructure for the preparation and storage of food at home (such as hardware rental programs). It is critical to ensure the implementation and maintenance of relevant recommendations from the National Indigenous Health Equality Summit,7
such as the target that healthy living practices like the ability to store, prepare and cook food are available in three-quarters of all houses by 2013. Poor quality diet in the Indigenous population is a significant risk factor for three of the major causes of death (cardiovascular disease, cancer and type 2 diabetes). Poor nutrition among many Indigenous people is associated with disadvantaged socio-economic circumstances. In order to improve nutrition in Indigenous communities, it is necessary to acknowledge and address the role of poverty.
Provide subsidies for rural and remote area transport of fresh foods.