May 25, 1999

To:Board of Health

From:Dr. Sheela Basrur, Medical Officer of Health

Subject:Cost of Healthy Eating in Toronto

Purpose:

This report provides an annual update on the cost of a Nutritious Food Basket in Toronto.

Source of Funds:

No funds are requested.

Recommendations:

It is recommended that:

(1)this report be received for information.

(2)this report be referred to the Social Services Division of Community & Neighbourhood Services; and

(3)Public Health work in partnership with the Social Services Division, Community & Neighbourhood Services, as well as with other agencies, to develop advocacy strategies to ensure that Toronto residents have sufficient income to purchase nutritious, affordable and culturally acceptable foods.

Background:

Boards of Health in Ontario are required to annually monitor the cost of a Nutritious Food Basket in accordance with the Ontario Ministry of Health's document, Monitoring the Cost of a Nutritious Food Basket Protocol (1998). This is a requirement specified in the Chronic Disease Prevention program standard, Mandatory Health Programs and Services Guidelines (December, 1997). The Ministry of Health recommends that information about the cost of a Nutritious Food Basket be used on an ongoing basis to promote and support policy development to increase access to healthy foods. The Nutritious Food Basket is a food costing tool that is a measure of the cost of healthy eating. Health Canada recently revised the Nutritious Food Basket as a national template, from which a provincial basket template was developed for local Boards of Health in Ontario. The revised tool requires that a list of 66 foods be priced in at least six different grocery stores, including major chains and independent stores, within each board of health's jurisdiction. The revised Nutritious Food Basket reflects both current healthy eating recommendations (as defined by Nutrition Recommendations, 1990 and Canada's Food Guide to Healthy Eating, 1992) and average food purchase patterns (Statistics Canada Food Expenditure Survey, 1996). The foods included are not intended to be a prescriptive list of what to eat, but instead provide a realistic example of foods that can be used to determine benchmark costs of healthy eating. Since the Nutritious Food Basket includes basic food items, it is relevant to people from most cultures; however, the basket does not reflect the eating patterns of any particular individual or any one culture. Differences in food preparation techniques and spices and condiments used will account for a large degree of the differences in dishes eaten among many cultures.

Comments:

Pricing a Nutritious Food Basket provides information on how much it costs to buy nutritious food. The Nutritious Food Basket is a very economical basket of foods and costs less than the food costs of average consumers, mainly because expensive food items, such as processed convenience foods, snack foods and foods of little nutritional value, are generally not part of the basket. Food dollars spent away from home are also not considered. Generally speaking, the Nutritious Food Basket tool is based on an assumption that people have the necessary food skills to be able to prepare most meals from scratch. In addition, non-food items that are typically purchased in grocery stores, such as soap, laundry detergent and paper products, are not factored into the cost of the basket. It is recognized, however, that such personal/household items are basic necessities and contribute significantly to household expenditures. Unfortunately, there is not yet an acceptable costing tool available to assist in benchmarking the costs of these other basic necessities, although there is a federal/provincial/territorial working group currently refining a "Market Basket Measure" as a tool to define poverty in Canada.

The Nutritious Food Basket protocol requires that pricing be done each year in May or June; therefore, Toronto Public Health staff conducted pricing in 12 grocery stores across the city during early May, 1999. The protocol called for the lowest price for food items in specified sizes, including sale-priced items, to be collected. The prices from all stores were averaged in the analysis program supplied by the Ontario Ministry of Health. The survey results were analysed according to the energy and nutrient needs of 23 age/gender groups, as defined in the 1990 Recommended Nutrient Intakes for Canadians, and are summarized in Table 1. Public Health staff have been in contact with Social Services staff regarding the latest pricing results and the implications for ongoing work to support nutritious and economical food selection and preparations.

Table 1 - Weekly Cost of Nutritious Food Basket in Toronto (May, 1999)

Gender Group	Age (years)	Cost Per Week ($)
Child	1 2-3 4-6	12.66 13.25 17.42
Boy	7-9 10-12 13-15 16-18	20.77 25.90 30.38 35.25
Girl	7-9 10-12 13-15 16-18	20.12 24.01 25.61 24.36
Man	19-24 25-49 50-74 75+	33.43 32.47 29.51 26.80
Woman	19-24 25-49 50-74 75+	24.94 23.83 23.44 22.81
Pregnancy Trimester 1 Trimesters 2,3 Lactation	13-15	28.34 29.88 30.66
Pregnancy Trimester 1 Trimesters 2,3 Lactation	16-18	29.32 30.33 31.08
Pregnancy Trimester 1 Trimester 2,3 Lactation	19-24	27.57 29.28 29.92
Pregnancy Trimester 1 Trimesters 2,3 Lactation	25-49	26.45 28.01 28.55

This information can be used to calculate the cost of a Nutritious Food Basket for any household by adding up the weekly food costs for each household member, based on each person's age/gender. To determine the household's monthly food cost, multiply the household's weekly food cost by 4.33. For example, the Nutritious Food Basket cost for a family of four, including two parents, a 13-year-old boy and an 8-year-old girl, is $106.80 per week or $462.44 per month. The protocol also includes information on how to adjust the results for household size since it costs more to feed a smaller household than a larger one on a per person basis.

It is important to note that the market share of the stores surveyed is not factored into the process of calculating the Nutritious Food Basket. Consequently, the unweighted nature of the results makes it inappropriate to compare pricing results among different Board of Health jurisdictions, e.g., Toronto versus Ottawa. It would also be inappropriate to compare these results to food pricing surveys based on previous editions of the Nutritious Food Basket, since this survey utilizes a different tool, revised to reflect the latest healthy eating recommendations.

Implications:

Table 2 provides a summary of some examples of the uses and implications of the Nutritious Food Basket in Toronto.

Table 2 - Examples of Uses and Implications of the Nutritious Food Basket

Potential Uses	Implications for Toronto Public Health
(1)Raise awareness of the cost of a Nutritious Food Basket.	Develop and distribute a factsheet on the Nutritious Food Basket, which will include latest pricing results, to community/social service agencies for use in their programs, services and policies, as well as to the media.
(2)Monitor changes in the actual dollar and cent cost of a Nutritious Food Basket.	Continue to price the Nutritious Food Basket each year, analyse the results and share the findings.
(3)Compare the cost of a Nutritious Food Basket to income.	Work with the Social Services Division to compare income, particularly social assistance rates and minimum wage levels, with basic living costs, i.e., Nutritious Food Basket results and costs of housing/shelter and other necessities (e.g., transportation, clothing, child care, etc.).
(4)Develop advocacy strategies to ensure that Toronto residents have sufficient income to purchase nutritious, affordable and culturally acceptable foods.	Work collaboratively with Social Services and other agencies to address long-term solutions to those issues that impact on the ability to afford the cost of healthy eating, such as affordable housing and adequate incomes.
(5)Utilize the concept of the Nutritious Food Basket in nutrition and food access programming in the community.	Provide food skills resources and programs, e.g. Cooking Healthy Together, in conjunction with partner agencies, in order to support economical and nutritious food selection and preparation.

Public health staff will also utilize the Nutritious Food Basket costing results in ongoing nutrition and food access programming in the community. Staff will continue to develop and offer food skill programs and resources, e.g., Cooking Healthy Together, throughout the city. The Nutritious Food Basket results can also be used in estimating the cost of feeding groups of people, e.g., families, group homes, shelters, etc. In addition, the tool can serve as an educational strategy for budgeting exercises in family studies courses and home management programs.

Conclusions:

The Nutritious Food Basket is a measure of the cost of healthy eating. It meets the energy and nutrient needs of most healthy Canadians at a reasonable cost. There is sufficient variety in the basket to accommodate various ethnic food practices. During May, 1999, a survey of 12 grocery stores in Toronto was completed using the Nutritious Food Basket tool in order to determine the cost of healthy eating in the city. This information will continue to be collected on an annual basis, as per Ontario Ministry of Health requirements. There is not yet an acceptable tool available for benchmarking the costs of other basic necessities required for healthy living.

The most important function of the Nutritious Food Basket is to provide information that can be used to promote and support policy development to increase access to healthy foods. Toronto Public Health staff will work in collaboration with staff in the Social Services Division, as well as with other partner agencies, to develop advocacy strategies to ensure that Toronto residents have sufficient income to purchase nutritious, affordable and culturally acceptable foods and to meet other basic living expenses essential for their overall health and well-being.

Contact Names:

Judi Wilkie

Manager, Healthy Lifestyles

East Region

Telephone: 397-4777

E-mail: jwilkie@borough.eastyork.on.ca

Carol Timmings

Regional Director

East Region

Telephone: 392-1355

E-Mail: ctimming@toronto.ca

Dr. Sheela V. Basrur

Medical Officer of Health