Time and money—the biggest hurdles to healthy eating
Philippe Couillard, the freshly defeated Quebec premier, made headlines during the election campaign when he suggested a family of three —comprised of one adult and two adolescents —could feed themselves for $75 a week.
That figure is less than half the minimum cost (between $168 to $207) of a nutritionally adequate diet for a family of this size, according to the Montreal Diet Dispensary.
While Couillard eventually conceded that it "would not be a varied menu," would require strict bargain-hunting, supplementing with food banks and would be "almost a full-time job," he stood by his statement.
Diet quality, health linked to social status
Research shows that in developed countries, more affluent and educated people tend to consume higher-quality diets —including more fruits and vegetables, fish and whole grains.
Conversely, socioeconomically disadvantaged people report diets that are nutrient-poor and energy-dense, replete with foods like pasta, potatoes, table sugar, fried foods and processed meats. They are less likely to have food-purchasing habits that conform to public health recommendations.
This inverse relationship between social class and diet quality and health is extensively documented. However, the research does not explain why this is the case —a question that has significant implications for designing effective policies and initiatives to improve diets and prevent chronic disease.
Public health & prejudice
Public-health initiatives to promote healthy diets often focus on providing nutrition education and recipes. These approaches, however, often presume less food literacy (i.e. food knowledge and skills) among low-income people. Are unhealthy diets really the result of poor choices, limited food skills and knowledge?
Research suggests that, in fact, adults in food-insecure households are just as likely as those in food-secure households to adjust recipes to make them more healthy. They are also just as proficient in food preparation and cooking skills. There is no indication that increasing food skills or budgeting skills will reduce food insecurity.
Instead, disadvantaged groups are constrained by their economic, material and social circumstances.
Higher-quality diets are costlier
It's well-established that food prices are an important determinant of food choice, particularly among low-income consumers. Low-income households report that they find it difficult to adopt dietary guidelines because food prices are a barrier to improving their diets.
When researchers estimate the cost of diets people actually eat, higher-quality diets are typically more costly. Some research suggests healthier diets cost, on average, approximately $1.50 a day more than less healthy choices. For low-income consumers, the cost of substituting healthier foods can represent up to 35 to 40 per cent of their food budget.
While this may be so, it does not, in itself, prove that healthy diets are necessarily more expensive or cost-prohibitive. After all, not all socioeconomically disadvantaged people consume poor diets.
We can easily think of a number of foods and recipes that are both inexpensive and nutritious. The internet is full of recipes for "eating well on a budget." Indeed, for many costly healthy food items like fresh salmon, a lower-cost alternative exists, like tinned salmon.
Some have even suggested that the higher relative cost of healthy foods is a myth and a problem that can be solved by healthy, low-cost meals.
Others maintain that poor diet is the result of poverty, not lack of education.
This begs the question: Do healthy foods really cost more?
'Apples to oranges' drives researchers bananas
Foods contain calories and a whole array of nutrients in different quantities that we require at different life stages in different amounts. At the same time, some ingredients must be limited, like sugar, sodium and saturated fat.
Researchers have developed indices like the Nutrient Rich Food Index to rank foods based on their composite nutrient profile, taking into account both the good and bad.
Food comparisons also require a standard unit of comparison and to this day, researchers are still debating —how do we effectively compare apples to oranges?
And when we add food price to the equation, how can we be sure we are getting the biggest nutritional bang for our buck?
When food prices are compared on the basis of average portion (like one apple versus one orange) or edible weight (like 100 grams), healthful foods can be cheaper for the consumer.
Calories cheap, nutrients expensive
However, when foods are compared based on their energy cost (amount of money per calorie), energy-dense foods like grains, fats and sweets represent the lowest-cost option. These cheap calories also tend to be the least nutritious.
While some researchers have argued that consumers don't purchase foods based on the cost of energy, others have shown that this metric best matches the actual consumption patterns for low-income people.
The fact that low-cost, energy-dense foods of low nutritional content are heavily relied upon by low-income consumers means we can't ignore this metric.
Not enough money, or time
Although nutritious, inexpensive food options do theoretically exist, whether they're accessible and feasible, particularly among the most socially disadvantaged consumers, has long evaded both nutrition researchers and politicians.
As Couillard admitted, his food budget would have demanded significant time and planning commitments.
The "time cost" to prepare raw food items relative to prepared or convenience products may lead to differing conclusions about relative prices of food —despite the higher price tag of prepared foods.
In fact, research suggests that time is more constraining than money in following nutritious food plans.
Access to a healthful diet is not just about food prices, which have have been rising across the country for several years; it's also about income and purchasing power. Low income is the strongest predictor of food insecurity in Canada, where one in eight households experience insufficient access to nutritious foods.
Modest improvements in income through policy instruments such as a basic income guarantee have been shown to be effective in reducing the probability of food insecurity among the poorest households. Such programs and policies, however, are left to the government of the day and a change in politics can signal the cancellation of such initiatives.
Meanwhile, emergency food relief programs, like food banks and soup kitchens, are left to charitable and private organizations, which some have argued permit the government to neglect social welfare obligations.
So, can the most socioeconomically disadvantaged people afford nutritious diets? Are healthy foods really more expensive?
Maybe we're asking the wrong questions about the true cost of food. As the UN special rapporteur on the right to food said of his 2012 mission to Canada: "The question of hunger is not a technical question, it's a political question."