Affordability of a Healthful Diet: A Systematic Review and Implications for Public Health

Issue: Public health professionals are first-line advocates for healthful eating, as unhealthful dietary behaviors may contribute to obesity and related negative health sequelea. However, encouraging healthful eating is complicated by the disputed affordability of such diets, particularly among those receiving Supplemental Nutrition Assistance Program (SNAP) benefits.

Description: This systematic review analyzes the methods, limitations, and results of market basket surveys (MBSs) to examine the affordability of diets meeting minimum daily dietary requirements of families. A multidisciplinary database search was utilized to identify 16 MBSs. For inclusion, MBSs had to be (1) performed in the U.S. and (2) price foods in grocery stores between 1985-2012. 

Lessons learned: Results indicated MBS methodology and study quality varied across studies. MBS price data indicated healthful diets for families are unaffordable when purchased from small/medium stores and over half of studies found healthful diets are also unaffordable at supermarkets.

Recommendations: When families struggle to afford food, stand-alone dietary education is not likely effective or ethically appropriate. Therefore, public health professionals must advocate for policies to increase both access to affordable healthful foods and SNAP benefits for low-income families, which were significantly cut with recent legislation. Advocacy must be bridged with local efforts including comprehensive education, counseling, and referrals (e.g., to food shelves, SNAP, Women, Infants and Children, National School Lunch Program). Such interventions will be enhanced by research on families’ food purchasing behaviors and how such behaviors intersect with food intake and health outcomes. Standards for future MBS research consistency and quality are also provided.