Competitive pricing for healthy foods

There is strong evidence that competitive pricing increases sales of healthy foods, including low-fat foods, fruits, vegetables, and water (Gittelsohn 2017, Grech 2015, Jaime 2009, Kocken 2012, An 2013, AHA-Mozaffarian 2012). Price discounts or subsidies for healthier foods can also increase healthier food consumption (Gittelsohn 2017, An 2013, AHA-Mozaffarian 2012).

Pricing affects individual behavior; adults and teenagers have been shown to purchase items that are lower in cost, whether those items are healthy or unhealthy (French 2001). Reductions in the price of low-fat snacks, fruits, and vegetables increase sales of these products (Gittelsohn 2017, Fox 2005a, Jaime 2009, Kim 2006, Kocken 2012, An 2013). The size of the price difference matters; larger price differences between lower cost healthy foods and higher cost unhealthy foods are linked to greater improvements in healthy food consumption (AHA-Mozaffarian 2012). Overall, pricing incentives improve dietary choices and change consumer behavior when implemented alone or in combination with other interventions such as nutrition education (Gittelsohn 2017).

Preliminary evidence from price discount interventions suggests that there is a strong demand for healthy foods such as fruits and low-fat snacks, such that a 1% price decrease is associated with more than a 1% increase in quantity demanded (An 2013). In some studies, positive behavior changes following subsidies that reduce the price of fruits and vegetables have been sustained several months after subsidies end. Other studies suggest that populations with lower incomes may be more sensitive to prices than those with higher incomes, and youth more sensitive than adults (AHA-Mozaffarian 2012).

Competitive pricing of healthier foods and beverages along with healthy food marketing strategies has been shown to improve weight status for children and adolescents, especially as part of a broader multi-component school-based intervention to improve the food environment (CG-Obesity).

Competitive pricing that increases the purchase and consumption of fresh fruits and vegetables, especially those grown locally and in season, instead of unhealthy, highly processed items may reduce fossil fuel energy used to produce, process, and transport food (Ringling 2020, Stone 2021, CCAFS-Campbell 2012). Competitive pricing initiatives may also reduce the energy intensity of an individual’s diet if more plant-based foods are consumed in place of animal products (Ringling 2020, Hamerschlag 2017).

Lowering the price of healthy foods or raising the price of unhealthy foods has not been shown to significantly decrease revenue in school settings (Fox 2009, Kim 2006, Kocken 2012), and in some cases, has increased revenue and total profits (Gittelsohn 2017). Distribution effects on obese and low-income populations should be taken into consideration when using strategies like competitive pricing of healthy foods (Zhen 2023).

It is unclear what impact competitive pricing of healthy foods can have on disparities in access and consumption of healthy foods among populations with lower income.

Many population groups in the U.S., especially people with low incomes and people of color, live and work in areas with an unhealthy food environment and have higher rates of food insecurity than people with higher incomes and white people (Kris-Etherton 2020). These disparities in access to and consumption of nutritious foods through financial barriers contribute to disparities in diet quality (Kris-Etherton 2020). Disparities in diet related health outcomes also persist by income level, race and ethnicity, education background, and geographic location in the U.S. (Brown 2022, Larson 2009).

Throughout U.S. history, discriminatory housing, lending, and exclusionary zoning policies entrenched racial residential segregation and concentrated poverty (Zdenek 2017, Kaplan 2007). This systemic disinvestment and exclusion by both government and private entities created and maintains community environments with limited resources, deteriorating infrastructure, hazardous industries and waste disposal sites, and many other factors that lead to poorer health outcomes for people of color and people with low incomes (Braveman 2022, Prochnow 2022, McAndrews 2022, Brookings-Semmelroth 2020).

Communities shaped by discriminatory policies are often areas that have limited access to healthy and affordable food, formerly known as food deserts (Beaulac 2009, Walker 2010b). Individuals who live in these communities face higher food costs, fewer store options, and must travel further to purchase healthy food than those who live in well-resourced communities (Beaulac 2009). Residents also have increased exposure to high calorie foods that have little nutritional value, which often leads to worse health outcomes (Walker 2010b). Many rural areas also lack access to fresh and affordable food, even in areas where farming is an important part of the local economy (RHIhub-Rural food and hunger). Foods that are higher in calories and less healthy are often more affordable than healthy food options because these foods cost less to manufacture, process, transport and store, government subsidies of commodities (e.g., corn) keep prices low, and there is higher demand for high caloric, shelf-stable foods (Rao 2013).

• Are there places in your community where competitive prices are already being implemented (i.e. schools, libraries, workplaces, vending machines etc.)? If not, where can competitive prices be introduced and implemented?
• Who can you partner with to bring competitive pricing for healthy foods and beverages to your community?
• Are there financial barriers or issues with accessing nutritious foods in your community? Can implementing competitive pricing help increase purchase of healthy foods for your community members?
• Who could benefit the most from more affordable healthy foods in your community? What other barriers prevent them from accessing healthy and nutritious food?

Many schools have implemented competitive pricing in their cafeterias and vending machines, including North Community High School in Minneapolis, MN; Vista High School in Vista, CA; the Fayette County Public School District in Lexington, KY (Fox 2005a); Marshall County Schools in AL; and Boston Public Schools (IPHI-HCFS).

Workplace wellness policies often include competitive pricing strategies in vending machines and cafeterias. For example, in Michigan, worksite wellness guides encourage large and small workplaces to adopt competitive pricing for healthy foods (MI DCH-HW guide 2012).

There are also many grocery stores, convenience stores, and other food retail outlets using competitive pricing to market healthy food options and promote fruit and vegetable sales as part of a healthy food retail model, for example, the Healthy Neighborhood Store Project in Omaha, Nebraska and Northgate Market in Inglewood, California (PolicyLink-HFA case studies).

Fresh for Less (FFL), a multi-component and equity-focused program in Austin, Texas has been implemented since 2017 in underserved communities to improve healthy food access. FFL brings healthy foods and fresh produce to communities through farmstands and mobile markets using competitive pricing (Janda 2022, Fresh for Less).

AHA-VFHK toolkits - American Heart Association (AHA). Voices for healthy kids (VFHK): Resources and toolkits.

ISU-Food and sustainability resources - Iowa State University (ISU), Sustainable Food Processing Alliance. Online resources for food and sustainability.

PolicyLink-HFA portal - PolicyLink, The Food Trust, Reinvestment Fund. Healthy food access portal: Research your community, change policy, launch a business, resources & tools.

* Journal subscription may be required for access.

AHA-Mozaffarian 2012 - Mozaffarian, D., Afshin, A., Benowitz, N.L., Bittner, V., Daniels, S.R., Franch, H.A., Jacobs, D.R., Kraus, W.E., Kris-Etherton, P.M., Krummel, D.A., Popkin, B.M., Whitsel, L.P., & Zakai, N.A. (2012). Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association (AHA). Circulation, 126(12), 1514-1563.

An 2013* - An, R. (2013). Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition, 16(7), 1215-1228.

Beaulac 2009 - Beaulac J, Kristjansson E, Cummins S. A systematic review of food deserts, 1966-2007. Preventing Chronic Disease. 2009;6(3):A105.

Braveman 2022 - Braveman PA, Arkin E, Proctor D, Kauh T, Holm N. Systemic and structural racism: Definitions, examples, health damages, and approaches to dismantling. Health Affairs. 2022;41(2):171-178.

Brookings-Semmelroth 2020 - Semmelroth L. How Wilmington, Del. is revitalizing vacant land to rebuild community trust. Washington, D.C.: Brookings Institution; 2020.

Brown 2022 - Brown AGM, Shi S, Adas S, et al. A decade of nutrition and health disparities research at NIH, 2010–2019. American Journal of Preventive Medicine. 2022;63(2):e49-e57.

CCAFS-Campbell 2012 - Campbell B. Is eating local good for the climate? Thinking beyond food miles. Research Program on Climate Change, Agriculture and Food Security (CCAFS), CGIAR Research Programs. 2012.

CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity.

Fox 2005a* - Fox S, Meinen A, Pesik M, Landis M, Remington PL. Competitive food initiatives in schools and overweight in children: A review of the evidence. Wisconsin Medical Journal. 2005;104(5):38-43.

Fox 2009* - Fox MK, Dodd AH, Wilson A, Gleason PM. Association between school food environment and practices and body mass index of U.S. public school children. Journal of the American Dietetic Association. 2009;109(2 Suppl):S108-S117.

French 2001* - French SA, Story M, Jeffrey RW. Environmental influences on eating and physical activity. Annual Review of Public Health. 2001;22:309-335.

Fresh for Less - Austin Texas Health Department. Fresh for less.

Gittelsohn 2017 - Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: A systematic review. Preventing Chronic Disease. 2017;14(E107):170213.

Grech 2015* - Grech A, Allman-Farinelli M. A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices. Obesity Reviews. 2015;16(12):1030-1041.

Hamerschlag 2017 - Hamerschlag K, Kraus-Polk J. Shrinking the carbon and water footprint of school food: A recipe for combating climate change. A pilot analysis of Oakland Unified School District's food programs. Friends of the Earth; 2017.

IPHI-HCFS - Illinois Public Health Institute (IPHI). Controlling junk food and the bottom line: Tip sheet 5: Improving cafeteria strategies to support healthier competitive foods standards (HCFS).

Jaime 2009* - Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Preventive Medicine. 2009;48(1):45-53.

Janda 2022 - Janda KM, Nielsen A, Phelps A, et al. Fresh for less: Cross-sector collaboration for funding, implementation, and evaluation of a local initiative to improve equitable healthy food access. Journal of Health Care for the Poor and Underserved. 2022;33:83-106.

Kaplan 2007* - Kaplan J, Valls A. Housing discrimination as a basis for Black reparations. Public Affairs Quarterly. 2007;21(3):255-273.

Kim 2006 - Kim D, Kawachi I. Food taxation and pricing strategies to “thin out” the obesity epidemic. American Journal of Preventive Medicine. 2006;30(5):430-437.

Kocken 2012* - Kocken PL, Eeuwijk J, Van Kesteren NMC, et al. Promoting the purchase of low-calorie foods from school vending machines: A cluster-randomized controlled study. Journal of School Health. 2012;82(3):115-122.

Kris-Etherton 2020 - Kris-Etherton PM, Petersen KS, Velarde G, et al. Barriers, opportunities, and challenges in addressing disparities in diet-related cardiovascular disease in the United States. Journal of the American Heart Association. 2020;9:e014433.

Larson 2009* - Larson N, Story M. A review of environmental influences on food choices. Annals of Behavioral Medicine. 2009;38(1 Suppl):S56-73.

McAndrews 2022* - McAndrews C, Schneider RJ, Yang Y, et al. Toward a gender-inclusive Complete Streets movement. Journal of Planning Literature. 2022;38(1):3-18.

MI DCH-HW guide 2012 - Michigan Department of Community Health (MI DCH). Our health begins with: The Michigan health and wellness 4 x 4 plan. 2012.

PolicyLink-HFA case studies - PolicyLink, The Food Trust, Reinvestment Fund. Healthy food access (HFA) portal: Our webinars and case studies.

Prochnow 2022* - Prochnow T, Valdez D, Curran LS, et al. Multifaceted scoping review of Black/African American transportation and land use expert recommendations on activity-friendly routes to everyday destinations. Health Promotion Practice. 2022.

Rao 2013 - Rao M, Afshin A, Singh G, Mozaffarian D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open. 2013;3(12).

RHIhub-Rural food and hunger - Rural Health Information Hub (RHIhub). Rural hunger and access to healthy food.

Ringling 2020 - Ringling KM, Marquart LF. Intersection of diet, health, and environment: Land grant universities’ role in creating platforms for sustainable food systems. Frontiers in Sustainable Food Systems. 2020;4(70).

Stone 2021 - Stone, T., Thompson, J., Rosentrater, K., & Nair, A. (2021). A life cycle assessment approach for vegetables in large-, mid-, and small-scale food systems in the midwest U.S. Sustainability, 13(20).

Walker 2010b - Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: A review of food deserts literature. Health and Place. 2010;16(5):876-884.

Zdenek 2017 - Zdenek RO, Walsh D. Navigating community development: Harnessing comparative advantages to create strategic partnerships. Chapter: The background and history of community development organizations. New York: Palgrave Macmillan; 2017.

Zhen 2023* - Zhen C, Chen Y, Lin BH, et al. Do obese and nonobese consumers respond differently to price changes? Implications of preference heterogeneity for obesity-oriented food taxes and subsidies. American Journal of Agricultural Economics. 2023;1-31.