The cost of a basket of foods that represent current nutrition recommendations and average food purchasing patterns. 

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)

http://www.ontario.ca/publichealthstandards

Personnel

• 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