Improving diet quality is a central component in the fight against obesity. One hotly debated topic is the role of prices for healthy foods and nutritionally less desirable foods, but little data is available. Congress has asked USDA to conduct a pilot study that provides discounts on healthy foods, but this project has not started yet and will be limited to selected individuals in a single county in Massachusetts. We propose to analyze data from a much larger program that was started in 2009 by the South African health insurance company Discovery. Discovery's HealthyFood program provides rebate of up to 25% on healthy items through a nationwide supermarket chain and presently enrolls about 200,000 households. Food items eligible for a discount on the HealthyFood benefit were selected in agreement with international and US dietary guidelines and are marked on cash register receipts and on the shelves. We will consider the overall impact of the program on purchases, diets, and health outcomes, and also try to separate out the effects of the financial incentives from the educational component and environmental changes that affect the whole population. Our primary statistical approach is difference-in-difference analysis (pre/post of individuals becoming eligible for benefit with control groups), complemented with additional statistical analyses to address selection biases. Data sources include both individual health surveys, sales data from supermarkets (individual line items and linkable to individuals), and health care claims.

Public Health Relevance

This project will evaluate a program that addresses a central issue to improve diet and prevent obesity: What if healthy foods were cheaper? About 200,000 households are currently enrolled in Discovery's HealthyFoodbenefit, a program that gives them a substantial rebate on their healthy food purchases. By studying changes in purchasing behavior, in self-reported diets, and in other health outcomes among HealthyFoodparticipants and a control group, we will be able to provide the first results on what meaningful price changes for healthier foods could achieve at the population level.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-PSE-H (80))
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Breen, Nancy
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Rand Corporation
Santa Monica
United States
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Sturm, Roland; An, Ruopeng (2014) Obesity and economic environments. CA Cancer J Clin 64:337-50
An, Ruopeng; Patel, Deepak; Segal, Darren et al. (2013) Eating better for less: a national discount program for healthy food purchases in South Africa. Am J Health Behav 37:56-61
An, Ruopeng (2013) Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Health Nutr 16:1215-28
Sturm, R; An, R; Maroba, J et al. (2013) The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme. S Afr Med J 103:840-4
Sturm, Roland; An, Ruopeng; Segal, Darren et al. (2013) A cash-back rebate program for healthy food purchases in South Africa: results from scanner data. Am J Prev Med 44:567-72