Food is not cheap. High quality food can be prohibitively expensive. Even people who want to improve their diet may be prevented from doing so because of the costs involved. There are ways to stretch a limited budget, but that takes time, knowledge and careful planning. For most consumers, money foremost determines what goes on their plate. No nutritional guidelines or recommendations can ignore that simple fact.
Many nutrition professionals seem to believe that almost all people, at least in the developed world, have equal access to fresh, wholesome food like fruit, vegetables, whole grains and lean meats. In reality, however, food prices pose a significant barrier for low-income individuals and families who must balance their dietary needs with affordability, says Adam Drewnowski, a professor of epidemiology at the University of Washington and director of the Center for Public Health Nutrition at the university's School of Public Health.
When people lose their jobs or fall ill, incomes drop and family budgets shrink, food choices quickly shift towards cheaper alternatives. Low cost energy-rich but nutrient-poor starches, added sugars and fats represent the most inexpensive way to fill hungry stomachs, he explains.
Another important factor is convenience, and not necessarily by choice. What he calls "time poverty" plays an important role in how food choices are made. In most households, there is no longer one person who can spend sufficient time on grocery shopping and meal preparation. This has produced tremendous changes in how people relate to food. Reliance on restaurant fare, fast food and frozen dinners dominates much of today's eating culture. Conversely, cooking from scratch has almost become a lost art.
This estranged relationship with our food sources has caused widespread consequences, including an onslaught of diet-related ailments like obesity, diabetes, heart disease, cancer, and more. Addressing any and all of these health concerns must include serious considerations about availability and affordability of food that is healthy and can help prevent disease.
Research has long shown the existence of close connections between food choices and price as well as access. For instance, studies found that subsidizing the production of fresh produce (the way corn, soy, sugar and other commodities are currently subsidized), and therefore lowering prices, would substantially increase consumption of these products, while taxing processed foods and sugary sodas, and therefore making those more expensive, would reduce usage.
Similarly, offering easier access to healthful foods in so-called "food-deserts," usually low-income neighborhoods where supermarkets and grocery stores are scarce, would make a difference in the affected consumers' behavior.
Although cost and accessibility are doubtlessly major determinants in food choices, addressing only those would not necessarily produce all of the desired solutions. As surveys have shown, supply and buying power alone do not automatically equate to better eating habits.
Education and knowledge that can lead to diet and lifestyle improvements is equally as important. And even knowledge is not always followed by the right action, especially when the advice that is given causes more confusion than clarification, as it is all too often the case.
Other factors to be taken into account are influences based on culture, upbringing and social status. Most eating preferences are established during childhood and adolescence, and they tend to continue into adulthood, particularly when geographic, social and cultural circumstances remain largely unchanged.
In the face of such complexities, there are no obvious answers to guide us. Manipulating pricing through subsidies and taxes could only go so far, even if it was seriously attempted at one point, which is unlikely, at least for the foreseeable future. In the meantime, providing more and better information, along with useful, practical advice that can realistically be followed by those it is supposed to benefit is our best bet.
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