Description | Specific Indicators | Ontario Public Health Standards (OPHS) | Corresponding Health Indicator from Statistics Canada and CIHI | Data Sources | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Cross-References to Other Indicators | Cited References | Other References | Changes Made | Acknowledgements
The cost of a basket of foods that represent current nutrition recommendations and average food purchasing patterns.
- Average weekly cost of a nutritious food basket for a reference family of four
- Average weekly cost of a nutritious food basket for 22 age and sex groups
Ontario Public Health Standards (OPHS) The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.
Outcomes Related to this Indicator
- Societal Outcome (Chronic Disease Prevention): An increased proportion of the population lives, works, plays, and learns in healthy environments that contribute to chronic disease prevention.
Assessment and/or Surveillance Requirements Related to this Indicator
- The board of health shall monitor food affordability in accordance with the Nutritious Food Basket Protocol, 2008 (or as current) and the Population Health Assessment and Surveillance Protocol, 2008 (or as current) (Chronic Disease Prevention)
Corresponding Health Indicator from Statistics Canada and CIHI
Original source: Public health unit Analysis Check List
Distributed by: Public health unit and/or Ontario Ministry of Health Promotion
Suggested citation: Cost of a Nutritious Food Basket (specify age and sex group(s) or reference family of four), Name of health unit and/or Ontario Ministry of Health Promotion, year(s).
- According to the Nutritious Food Basket Protocol, 20081, food costing is coordinated by a board of health Registered Dietitian (RD).
- The Dietitian’s role includes reviewing food cost data collected in local grocery stores for quality assurance purposes. She/he ensures that the prices are in a form that can be entered into the cost averaging spreadsheet provided by the Ministry of Health Promotion. This includes checking that prices for fresh produce are in a per kilogram format, and checking that for packaged foods, if a specified purchase unit was not available and the price for an alternative sized product has been recorded, the price is correctly adjusted.
- Two surveyors are required to conduct the costing at the same time on the same day in order to reduce errors in data collection. The surveyor does not have to be a RD; rather, he/she can be a Board of Health designate or staff member with food knowledge and math skills.
Selection of grocery stores
- Foods are priced in a minimum of six stores according to store selection criteria. The stores selected by the health unit for pricing may vary from year to year within a Health Unit jurisdiction. Store selection should represent the types of stores where individuals in a given health unit typically shop.1 2
Data collection and analysis
- Pricing is done during a two-week period in May. If more than one store is priced from a grocery store chain, all stores within the chain must be priced in the same promotional week.
- A fixed basket of 67 foods in specified purchase units are priced.
- For each item in the basket, the lowest price available in the store in the specified purchase size is recorded.
- The resulting food basket cost for each health unit is based on the average cost of each food item from all grocery stores sampled.
- Once food prices from each selected store are entered into the cost averaging spreadsheet, the cost of the food basket for the 22 age and sex groups and the reference family of four are automatically generated by the spreadsheet.
- Users of the cost information are to apply a household size adjustment factor to account for economies and diseconomies of scale (as it costs less per person to feed a larger family and more per person to feed a smaller family). Adjustment factors are provided in the Nutritious Food Basket Guidance Document, February 2010.2
- Cost averaging spreadsheets are completed by Health Units and returned to the Ministry of Health Promotion by July 1 of each year. Health Unit results are collated and a provincial average is calculated by an Ontario Ministry of Health Promotion epidemiologist or designate. The provincial average (provided annually) is a simple average of all of the boards of health that calculated the cost of the nutritious food basket. Each board of health contributes equal weight to the calculated provincial average.
- An additional 5% is automatically added to the cost of the food basket (within the spreadsheet calculations) to cover the cost of miscellaneous foods used in meal preparation (spices, seasonings, condiments, baking supplies, soup).2
- For the most part, the food basket excludes processed convenience foods, snack foods, and foods of little nutritional value.2
- Infant formula and baby foods are not included.2
- The basket does not include foods that are purchased for religious or cultural reasons (e.g. kosher, halal).2
- Special diets that address specific disease conditions such as heart disease, diabetes, celiac, etc. are not included.2
- Food dollars spent away from home are not factored in the cost of the basket.2
- It is assumed that individuals always buy according to the lowest price and not necessarily according to need, preference or availability.2
- It is assumed that the individual has the time, ability and food skills to prepare meals from scratch.2
- It is assumed that the individual has access to grocery stores, literacy and language skills to shop for the lowest price.2
- It is assumed that grocery shopping is a regular activity (every 1 to 2 weeks). The frequency of shopping impacts package sizes that are purchased.2
- Because the food basket is based on average household purchasing patterns, the specific food purchasing patterns of any one person, or ethnic, or age group, are not represented.2
- If food items are not available in the specified purchase units, the modified calculation may raise or lower the cost of that food item. The package sizes priced, although representing an amount that is reasonable for a family of four to use in a week may not be the most economical size for that food item.2
- The cost of the Nutritious Food Basket is calculated by averaging the cost of individual food items across stores. Because market share of stores priced is not factored into the process of calculating cost, the resulting cost is an unweighted average. A weighted average would include the calculation of the importance of any one store or chain within the marketplace.2
- Most consumers are accustomed to purchasing non-food items at grocery stores such as laundry detergent, toilet paper or soap. If consumers compare their own food costs to the cost of the Nutritious Food Basket for their household, non-food items would have to be excluded from the consumers’ usual grocery store expenditures.2
- Making between-store comparisons would violate the principles of confidentiality and therefore must not be published.2
- The National Nutritious Food Basket is the food costing tool used by most provinces. However, the national basket is often adapted by provinces to reflect regional differences in food consumption patterns. Store selection criteria also vary considerably, making comparisons between and among provinces inappropriate.2
- The Nutritious Food Basket is a powerful policy and advocacy tool. Inappropriate use of the Nutritious Food Basket costs results in the data being discredited. Examples of misuse of the data include: 1) Using the Nutritious Food Basket as a budgeting tool; 2) Public release of store names and/or individual store data could jeopardize participation and the validity of food costing in the community; and 3) Publications of menus based on the list of foods in the Nutritious Food Basket. This suggests that the list of foods is being recommended as a healthy way of eating. The list of foods provides examples of foods that can be used only to determine benchmark costs of healthy eating.
Method of Calculation
- Instructions for calculating the cost of the food items in the Nutritious Food Basket are provided in the Nutritious Food Basket Guidance Document, February 2010.2
- Reference family of four: (a man and woman each age 31 - 50; a boy age 14 - 18; and a girl age 4 - 8).2
- 22 age and sex groups: Boy age 2 - 3 and 4 - 8; girl age 2 - 3 and 4 - 8; males age 9 - 13, 14 - 18, 19 - 30, 31 - 50, 51 - 70 and over 70; females age 9 - 13, 14 - 18; 19 - 30, 31 - 50, 51 - 70 and over 70; pregnancy age 18 and younger, 19 - 30 and 31 - 50; lactation age 18 and younger, 19 - 30 and 31 - 50.2
- Geographic areas: Public health unit; provincial average.2
- A nutritious food basket is a survey tool that is a measure of the cost of basic healthy eating that represents current nutrition recommendations and average food purchasing patterns.
- Food costing can be used to monitor both affordability and accessibility of foods by relating the cost of the food basket to individual and household incomes.1 Without consistent economic access to sufficient nutritious food, healthy eating cannot be achieved, increasing the risk of poor health.3
- Health units price the nutritious food basket and use the cost information in accordance with the Nutritious Food Basket Protocol, 2008 (or as current)1 and the Nutritious Food Basket Guidance Document, February 2010.2
- The Nutritious Food Basket Guidance Document, February 2010 applies the list of foods in the 2008 National Nutritious Food Basket.4 This food basket reflects an example of an eating pattern that meets Eating Well with Canada's Food Guide, and eating behaviours of Canadians from the Canadian Community Health Survey 2004 (Nutrition Focus).2 The National Nutritious Food Basket supporting documents include a list of foods, suggested purchase units and a food costing spreadsheet. The Ontario Ministry of Health Promotion uses this information to create a food costing protocol with supporting documents that can be found within the Nutritious Food Basket Guidance Document, February 2010.2
- The purpose of the Nutritious Food Basket Protocol, 2008 (or as current) is to provide direction to boards of health in regard to fulfilling the requirement of monitoring food affordability. Boards of health can use the costing information for program planning; to inform policy decisions; and to support and promote access to nutritious, safe, personally acceptable foods.1
The mix of stores and the approach to store selection may be quite different between health units, making between health unit comparisons inappropriate.
- Assuming that a health unit’s procedures are consistent over time, it is reasonable to compare a health unit’s percent change in NFB costs from one year to the next, although 2009 will be an exception, as the items in the 2009 Nutritious Food Basket are different than the foods selected in 2008.2 Ontario health units have priced the Nutritious Food Basket annually since 1999. However, starting from 2009 the protocol for measuring the cost of the Nutritious Food Basket changed and therefore cannot be compared to the cost of the earlier Nutritious Food Basket unless a "parallel period" approach is used. (See the Nutritious Food Basket Guidance Document, February 2010,2 Appendix J: Frequently Asked Questions; Question 14.)
Cross-References to Other Indicators
- Ontario Ministry of Health and Long Term Care. Nutritious Food Basket Protocol, 2008.
- Ontario Ministry of Health Promotion. Nutritious Food Basket Guidance Document, February 2010. Available online at: http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/guidance.html (Accessed April 26, 2010).
- Health Canada. Office of Nutrition Policy and Promotion, Health Products and Food Branch. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004) – Income-Related Household Food Security in Canada. (Catalogue No. H164-42 / 2007E). Ottawa, Ontario: Health Canada, 2007.
- Health Canada. 2008 National Nutritious Food Basket. Available online at: http://www.hc-sc.gc.ca/fn-an/surveill/basket-panier/index-eng.php(Accessed February 25, 2009).
Type of Review - Formal or Ad Hoc?
Changes made by
June 15, 2009
Healthy Eating and Active Living Subgroup of the Core Indicators Working Group
- This indicator was updated based on the Nutritious Food Basket Protocol, 2008 and the Nutritious Food Basket Guidance Document (Draft), April 2009.
- A section on the 2008 Ontario Public Health Standards was added to replace the section on Corresponding Mandatory Objectives (from the 1997 Mandatory Health Programs and Services Guidelines).
- All sections were updated to reflect the Guide to Creating or Editing Core Indicator Pages.
- The Description and Specific Indicators sections were changed to be more consistent with the format of other indicators.
- Comments were added under Analysis Check List to explain why no analysis is done by an Epidemiologist or Health Analyst at the PHU level.
- Comments were added to clarify how the Nutritious Food Basket is measured.
- A comment was added to link healthy eating and income.
Jennifer Skinner, Haliburton, Kawartha, Pine Ridge District Health Unit
Peggy Patterson, Renfrew County and District Health Unit
Ahalya Mahendra, Public Health Agency of Canada
|Contributing Author(s)|| |
Julie Stratton, Region of Peel Public HealthKrista Burns, Ministry of Health Promotion and Sport