Competitive pricing for healthy foods

Competitive pricing assigns higher costs to non-nutritious foods than nutritious foods. Competitive pricing can include incentives, subsidies, or price discounts for healthy foods and beverages as well as disincentives or price increases for unhealthy foods and beverages. Competitive pricing can be implemented in various settings, including schools, worksites, grocery stores or other food retail outlets, cafeterias, and vending machines.

Expected Beneficial Outcomes (Rated)

  • Increased sales of healthy foods

Other Potential Beneficial Outcomes

  • Increased healthy food consumption

Evidence of Effectiveness

There is strong evidence that competitive pricing increases sales of healthy foods, including low-fat foods, fruits, vegetables, and water (Gittelsohn 2017, Grech 2015*, Jaime 2009*, Kocken 2012*, An 2013*, AHA-Mozaffarian 2012). Price discounts or subsidies for healthier foods can also increase healthier food consumption (Gittelsohn 2017, An 2013*, AHA-Mozaffarian 2012).

Pricing affects individual behavior; adults and teenagers have been shown to purchase items that are lower in cost, whether those items are healthy or unhealthy (French 2001*). Reductions in the price of low-fat snacks, fruits, and vegetables increase sales of these products (Gittelsohn 2017, Fox 2005a*, Jaime 2009*, Kim 2006, Kocken 2012*, An 2013*). Effect sizes tend to be proportional; larger price differences between lower cost healthy foods and higher cost unhealthy foods are linked to greater improvements in healthy food consumption (AHA-Mozaffarian 2012). Overall, pricing incentives improve dietary choices and change consumer behavior when implemented alone or in combination with other interventions such as nutrition education (Gittelsohn 2017).

Preliminary evidence from price discount interventions suggests that the demand for healthy foods such as fruits and low-fat snacks are price elastic, which means a 1% price decrease is associated with more than a 1% increase in quantity demanded (An 2013*). In some studies, positive behavior changes following subsidies that reduce the price of fruits and vegetables have been sustained several months after subsidies end. Other studies suggest that lower income populations may be more sensitive to prices than higher income populations, and youth more sensitive than adults (AHA-Mozaffarian 2012).

Competitive pricing of healthier foods and beverages along with healthy food marketing strategies has been shown to improve weight status for children and adolescents, especially as part of a broader multi-component school-based intervention to improve the food environment (CG-Obesity).

Lowering the price of healthy foods or raising the price of unhealthy foods has not been shown to significantly decrease revenue in school settings (Fox 2009*, Kim 2006, Kocken 2012*), and in some cases, has increased revenue and total profits (Gittelsohn 2017).

Impact on Disparities

No impact on disparities likely

Implementation Examples

Many schools have implemented competitive pricing in their cafeterias and vending machines, including North Community High School in Minneapolis, MN; Vista High School in Vista, CA; the Fayette County Public School District in Lexington, KY (Fox 2005a*); Marshall County Schools in AL; and Boston Public Schools (IPHI-HCFS).

Workplace wellness policies often include competitive pricing strategies in vending machines and cafeterias. For example, in Michigan and North Dakota, worksite wellness guides encourage large and small workplaces to adopt competitive pricing for healthy foods (MI DCH-WW guide 2008, ND WW-Resources). 

Implementation Resources

AHA-VFHK toolkits - American Heart Association (AHA), Robert Wood Johnson Foundation (RWJF). Voices for healthy kids (VFHK): Toolkits to make the healthy choice the easy choice in the places where children live, learn and play.

Citations - Evidence

* Journal subscription may be required for access.

Gittelsohn 2017 - Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: A systematic review. Preventing Chronic Disease. 2017;14(E107):170213.

Grech 2015* - Grech A, Allman-Farinelli M. A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices. Obesity Reviews. 2015;16(12):1030-1041.

Jaime 2009* - Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Preventive Medicine. 2009;48(1):45-53.

Kocken 2012* - Kocken PL, Eeuwijk J, Van Kesteren NMC, et al. Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study. Journal of School Health. 2012;82(3):115–22.

An 2013* - An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition. 2013;16(7):1215-28.

AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514–63.

French 2001* - French SA, Story M, Jeffrey RW. Environmental influences on eating and physical activity. Annual Review of Public Health. 2001;22:309–35.

Fox 2005a* - Fox S, Meinen A, Pesik M, Landis M, Remington PL. Competitive food initiatives in schools and overweight in children: A review of the evidence. Wisconsin Medical Journal. 2005;104(5):38-43.

Kim 2006 - Kim D, Kawachi I. Food taxation and pricing strategies to “thin out” the obesity epidemic. American Journal of Preventive Medicine. 2006;30(5):430-7.

CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity.

Fox 2009* - Fox MK, Dodd AH, Wilson A, Gleason PM. Association between school food environment and practices and body mass index of US public school children. Journal of the American Dietetic Association. 2009;109(2 Suppl):S108-S117.

Citations - Implementation Examples

* Journal subscription may be required for access.

Fox 2005a* - Fox S, Meinen A, Pesik M, Landis M, Remington PL. Competitive food initiatives in schools and overweight in children: A review of the evidence. Wisconsin Medical Journal. 2005;104(5):38-43.

IPHI-HCFS - Illinois Public Health Institute (IPHI). Controlling junk food and the bottom line: Tip sheet 5: Improving cafeteria strategies to support healthier competitive foods standards (HCFS).

MI DCH-WW guide 2008 - Michigan Department of Community Health (MI DCH). Michigan's healthy workplaces resource guide: A worksite wellness resource guide for Michigan worksites - large and small (WW guide). 2008.

ND WW-Resources - North Dakota Worksite Wellness (ND WW). Worksite wellness building a healthy North Dakota: Additional resources: Nutrition.

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