Paper: Eating Better for Less: A National Discount Program for Healthy Food Purchases In South Africa (2012 APPAM Fall Research Conference (November 8

Friday, November 9, 2012

Liberty A & B (Sheraton Baltimore City Center Hotel)

*Names in bold indicate Presenter

Ruopeng An¹, Deepak Patel², Darren Segal³ and Roland Sturm¹, (1)RAND Corporation, (2)University of Cape Town, Cape Town, South Africa, and Discovery Health, Johannesburg, South Africa, (3)Discovery Health, Johannesburg, South Africa

Background: Diet quality is a central component in population health. While hotly debated, It is not known whether a price discount on fruits, vegetables, or other healthy foods can meaningfully change dietary behaviors in the population, let alone reduce the prevalence of obesity. A pilot study is planned in 2012 for one county in Massachusetts. However, in South Africa, a similar discount program has been operating nationwide since February 2009.

Aim: Examine whether reducing prices for healthy food purchases leads to changes in self-reported measures of food consumption and weight status.

Methods: The HealthyFood program launched by the health insurance company Discovery provides 10% to 25% discount on selected food items to nearly 260,000 households in about 800 supermarkets across South Africa. Health plan members repeatedly filled out health risk assessments that included questions on diets and body weight/height.

Results: A 10% and 25% discount on healthy food purchases is associated with an increase in daily fruits and vegetables consumption by 0.38 (95% CI: 0.37 - 0.39) and 0.64 (95% CI: 0.62 - 0.65) servings, respectively. Individuals receiving a 10% and 25% discount are significantly more likely to have three or more servings of wholegrain foods in a daily basis with an odds ratio (OR) of 2.05 (95% CI: 1.97 - 2.13) and 2.96 (95% CI: 2.84 - 3.08) respectively, but less likely to regularly have foods high in sugar with an OR of 0.73 (95% CI: 0.69 - 0.76) and 0.35 (95% CI: 0.34 - 0.37), foods high in salt with an OR of 0.59 (95% CI: 0.55 - 0.62) and 0.26 (95% CI: 0.25 - 0.28), fried foods with an OR of 0.53 (95% CI: 0.50 - 0.55) and 0.26 (95% CI: 0.25 - 0.27), processed meats with an OR of 0.71 (95% CI: 0.68 - 0.74) and 0.33 (95% CI: 0.31 - 0.34), and fast-food with an OR of 0.54 (95% CI: 0.51 - 0.56) and 0.28 (95% CI: 0.27 - 0.29), respectively. There is no strong evidence that participation in the HealthyFood program reduces obesity rates or lower body mass index.

Conclusions: A substantial price intervention might be effective in improving diets.

Poster Paper: Eating Better for Less: A National Discount Program for Healthy Food Purchases In South Africa