Food choices, food security, and food policy.

• Author: Dimitri, Carolyn
• Position: Global Economy - Report

Economics, nutrition, and public health literature includes much research on the factors that influence food choices and attempts to understand the factors contributing to low food security. Economic factors, such as prices and income, influence food choices and food security, as do access and availability of food. Yet recent literature indicates that behavioral factors--such as the physical environment and marketing strategies, including package size and product placement--have equal importance. The policies currently in place are only partially effective in terms of changing diet and enhancing food security, particularly for low-income consumers. We argue that, while increasing access to food through monetary transfers and enhanced food availability is important and essential, on their own these instruments are inadequate to reduce food insecurity. Policies must begin to address the third crucial element: the behavioral factors that influence our food choices.

**********

Despite widespread governmental efforts to promote healthy eating by providing messaging that a healthy diet consists of minimally processed, low-calorie foods, Americans continuouslv fail to meet the dietary guidelines for a healthy diet. Evidence indicates that most Americans consume an inadequate amount of whole grains, fruits, and vegetables, and an excessive amount of saturated fat and convenience foods. (1) Part of the problem is the cost of healthy food and that the price of fresh fruits and vegetables is high (and rising) relative to high-calorie processed foods. (2) The price differential between healthy and unhealthy food partially explains the established link between obesity and food insecurity, particularly for women. (3) That said, the higher cost of a healthy diet is unlikely to completely account for the fact that across socioeconomic groups, American diets fall well below the quality recommended by the dietary guidelines. Furthermore, food has become less costly relative to household income, as Americans spend a smaller share of their income on food than in years past; in 1929, food costs comprised 23 percent of personal disposable income, but made up just 10 percent in 2012. (4) Therefore, from a long run perspective, food prices cannot fully explain dietary deficiencies. (5) Evidence further suggests that, in the United States, time scarcity, either real or perceived, is another important aspect of diet quality: individuals spent 38 percent less time on meal preparation and shopping in 1995-1998 in comparison to 1965. (6)

The U.S. Department of Agriculture classifies food insecurity in America according to severity. In its most severe form, "very low food security" refers to individuals who consume an insufficient amount of food, due to lack of physical or economic access to food. The less severe form, known as "low food security," exists when individuals do not experience hunger, but consume low quality or a limited variety of food. (7)

Researchers have extensively studied the relationship between low food security--the focus of this paper--and limited access, investigating both physical access to food in stores and economic access in terms of food affordability. (8) An emerging area of economic research examines the behavioral causes of food choices, choices that help to account for deviations from a healthy diet. Evidence of such behavioral implications can be found in countries such as Mexico, where the infusion of large soda bottles and other processed, unhealthy foods, has contributed to a spike in obesity rates. (9) In the United States, evidence suggests that, despite the income transfer provided by federal nutritional benefits, many recipients of such transfers remain food insecure, consume an overall low quality diet, and in some cases, are more likely to be obese. (10) Access to nutrient-poor, calorie-dense food does not enhance food security.

New behavioral research suggests that many factors divert our attention from the quantity and quality of food consumed. Research suggests that we generally lack awareness of the sheer number of food decisions we make on a daily basis, let alone the environmental factors that influence our dietary composition and consumption volume. (11) From the use of labels and health claims, to packaging and shelf and point of purchase displays, marketing influences the types of products we purchase. (12) Elements of the eating environment, which include dining company, ambiance, plate and cup size, and portion size, can act as cues that guide the volume of food consumed, and often encourage excessive consumption. (13)

National and local policies aimed at addressing food insecurity target economic and geographic access to food, through programs such as federal nutrition benefits (e.g., Supplemental Nutrition Assistance Program, or SNAP), tax incentives (e.g., Healthy Food Financing Initiative), or promotion of farmers' markets. (14) Increasing access through monetary transfers and enhanced food availability is important and essential, but we argue that on their own these instruments do not adequately reduce food insecurity. The behavioral element--the factors that influence what and how much food we consume--is crucially missing from food security policy.

FOOD CHOICES AND IMPLICATIONS FOR FOOD SECURITY

Ultimately, the choice of food consumed, in terms of quality and quantity, has implications for personal health. Food choice includes the selection of food eaten at home as well as out of the home, with each setting providing a different set of challenges for the consumption of a healthy diet. Food eaten at home depends upon the availability of nutritious food at stores such as supermarkets, grocery stores, and smaller convenience stores, while food eaten away from home is dependent upon available choices, time to eat, and affordability of choices at restaurants, fast-food outlets, and schools. Both for food eaten at home and for that eaten away from home, income, prices, and marketing are influential factors, in addition to non-economic cues.

Food Choice and the Food Environment

Research shows that the food environment, or the availability of food stores in a neighborhood and the types and prices of products they carry, has a particularly substantial influence on diet quality for low-income individuals. (15) Businesses make their location decisions based on profit potential; location decisions lead to variability in the types of food stores and restaurants available from one neighborhood to another. Fewer chain stores are located in urban areas, which may result from relatively high development costs, high crime rates, and high security costs in such areas. (16) As a result, disparities exist between low-income (typically urban and rural) and affluent (typically suburban) neighborhoods regarding accessibility to different types of food stores. (17) In urban and rural areas, smaller food stores and convenience stores are prevalent, while larger supermarkets dominate in suburban food environments. Smaller food stores, including convenience stores, carry a relatively higher percentage of processed foods than chain supermarkets do; the food is generally of lower quality and is typically more expensive than that found in supermarkets. (18) In contrast, residents of suburban communities have access to more supermarkets and to a better selection of healthy foods.

Additionally, low-income and non-white individuals have more fast-food restaurants than their counterparts in general. Neighborhoods with higher proportions of black residents have both more fast-food restaurants and fewer supermarkets than white and racially-mixed neighborhoods. (19) Non-fast food restaurants have been found to be more prevalent in racially mixed and white neighborhoods than in black or Hispanic neighborhoods. (20) Studies have also found higher proportions of fast-food restaurants in low-income areas compared to more affluent areas. (21) As a consequence of their proximity to fast-food restaurants and small food stores...