Food Subsidy Programs and Health Promotion: A Narrative Review

Abstract

An unhealthy diet is a risk factor for non-communicable diseases (NCDs) and death. Food policies are suggested as interventions to improve diet and thus reduce NCDs. This study summarizes the recent evidence of the effect of food subsidy programs.

A narrative review was performed of studies, reporting the effect of food policies on dietary intake and related outcomes

Order custom essay Food Subsidy Programs and Health Promotion: A Narrative Review with free plagiarism report

450+ experts on 30 subjects Starting from 3 hours delivery

Get Essay Help

There is a potential for taxation and subsidy intervention to influence dietary intake. If the changes in diet were continuous, the improved intake of healthy foods, such as fruit and vegetables, can decrease the rate of chronic diseases. Thus, food subsidy programs for vulnerable groups should focus on improving nutritional status in a longer time. More prospective studies and economic analyses are needed to confirm the health benefits of food subsidy programs.

Introduction

Non-communicable diseases (NCDs) mainly diabetes, cardiovascular disease, and cancer are the most causes of death worldwide The majorities of the NCDs-related deaths occur in low- and middle-income countries, however, they are largely preventable {Organization, 2015 #33}. According to WHO, unhealthy diets and sedentary lifestyle, tobacco use and overconsumption of alcohol are the common risk factors of deaths {Organization, 2015 #33}on the other hand, a healthy diet is the main factor in improving health {Kheirouri, 2015 #32}.

A recent study in Iran reported that 90% of deaths result from ischemic heart disease and dietary risks, high body mass index, physical inactivity, and elevated high blood pressure, are important risk factors among adults {Forouzanfar, 2014 #31}Thus; diet and physiological risk factors are two potential targets for public health policy in Iran {Forouzanfar, 2014 #31}Dietary factors related to chronic disease and deaths from NCDs include inadequate intake of fruits and vegetables, high intake of salt, saturated fats and trans-fatty acids {Micha, 2014 #24{Kaiser, 2014 #25}{Imamura, 2015 #26}{Haynes-Maslow, 2013 #27}{Di Noia, 2014 #28}{Bauer, 2014 #29}{Ananthakrishnan, 2014 #30}}

According to the literature, food prices and diet cost, as well as the taste of food, dietary habits, and limited knowledge of nutritional values of foods, are barriers to healthy eating {{Bales, 2017 #22}Spaeth, 2014 #21{Allison, 2017 #23}}Lower socioeconomic status is associated with lower uptake of healthy behaviors {Needham, 2013 #20}. Food subsidies and/or higher pricing (taxation) are suggested as two population-based interventions that might enhance healthier eating {Niebylski, 2015 #19}Programs such as food subsidies are necessary to reduce the risk of nutrition-related diseases ({Afshin, 2015 #18}{Alagiyawanna, 2015 #17}{Powell, 2009 #16}{Hawkes, 2015 #15}{Mhurchu, 2015 #14}). Food subsidy programs are components of food pricing strategies have been taken for many years in the United States and the United Kingdom. The specific Supplementary Nutrition Program for Women, Infants, and Children (WIC) in the United States commenced in 1972 to provide healthy foods, referrals to health and social services and nutrition education to pregnant women and families with young children {Psota, 2017 #13}.

Additionally, there is mounting evidence on food policies and subsidy reforms in developing countries, such as those of Ramadan and Thomas {Ramadan, 2011 #12}who have analyzed the structure, performance, and political economy of the Egyptian food subsidy system and Sharma {Aune, 2017 #11}for India. Conversely, there are limited studies in the case of Iran; this paper has aimed to partially fill this gap.

How Effective Are Targeted Food Taxes and Subsidies?

Fruit and vegetable intakes are associated with reduced risk of several common chronic diseases including cancer, cardiovascular disease, and all-cause mortality {Aune, 2017 #10}. Over the past few decades, the price of fruits and vegetables has increased in parallel with the rise in obesity and related chronic non-communicable diseases {Kuchler, 2008 #9}. Recent studies indicate that subsidies on fruits and vegetables can be beneficial to improve fruit and vegetable consumptions. A 2013 review revealed that subsidies increased consumption of healthy foods including fruits and vegetables {Powell, 2013 #8}.

In this regard, lower fruit and vegetable prices are reported to be associated with lower body weight outcomes among both low-income children and adults, suggesting that subsidies that would reduce the cost of fruits and vegetables for lower socioeconomic populations may be effective in reducing obesity {Powell, 2013 #7}. Offering a subsidy for fruits and vegetables among WIC (Women, Infants, and Children) participants have been effective to increase F&V intake{Herman, 2008 #6}Additionally, WIC was associated with improved birth outcomes, especially among more disadvantaged women, such as teen mothers, and those who received public assistance last year {Bitler, 2005 #5}.Another report in WIC program indicated the moderate effects on the health of newborns{Foster, 2010 #4}; however, the effectiveness of the program for postpartum women is not addressed.

Darmon et al {Darmon, 2014 #3}reported that subsidizing healthy products while taxing unhealthy ones improved some aspects of the nutritional quality of food choices in both low and medium-income groups. However, low-income women derived fewer aids and nutritional benefits from applied food subsidies and taxes than those with medium-income. The authors concluded that food price policies may improve diet quality nevertheless increasing socio-economic disparities in nutrition {Darmon, 2014 #3}. In many types of research, low-income women purchased less important fruit, vegetables and other healthy products, and more unhealthy products, than medium-income women did. The result of one study indicates that the poor people have less bendable food dietary patterns, in accordance with the food monotony associated with poverty {Hamelin, 2002 #25}

Some researchers using price elasticity data derived from econometric designs showed that taxing unhealthy foods has small effects on the nutritional quality of the whole diet, meanwhile, food tax combined with appropriate subsidies could be more efficient ({Thow, 2010 #24}{Thow, 2010 #23}). Food taxes in combination with food subsidies was also considered as a good way to alleviate potential regressively “by enabling consumers to switch to more healthy products without incurring additional cost {Thow, 2010 #22}

It should be noted that much of the dietary intake data are based on self-report, which has well-recognized limitations such as inaccuracy. More precise and objective measures of dietary intakes, such as biomarkers including carotenoids and electronic shopping data have the potential to complement self-reported intake data and are suggested ({Almond, 2011 #21}, {Baldrick, 2011 #20}).

The Targeted Subsidies Policy in Iran

The impact of the targeted subsidies policy on health behavior and nutritional status among Iranian population is poorly investigated. The effect of the targeted subsidies program on food security in Iran during 2005-2012 is recently reported {Hosseini, 2016 #19}, an inverse relationship between the subsidy reform program and food security among Iranian households has been found.

Another study reported the effect of the implementation of TSP on the households' food security of Iran during 2007-2014 {Hosseini, 2017 #18}The findings revealed that the TSP resulted in increased use of low-cost and high-energy foods, and decreased the quality of energy intake. It should be stated that TSP is associated with the increase in prices due to the elimination of government supports, thus, households were more likely to consume affordable and calorie-dense foods, regardless of their quality. To explain details, consumption of protein sources including dairy and red meat decreased, and the consumption of foods such as sweets and fats increased.

Such dietary patterns would increase the susceptibility to obesity-related diseases including diabetes. Based on the WHO (2016) reports (http://www.who.int/diabetes/countryprofiles/ en.) the prevalence of diabetes was increased from 8.1% in 2008 to 10.3% in 2014.

Doshmangir et al {Doshmangir, 2015 #17}reported the negative effects of targeted subsidies on individuals` health behavior. Paying cash subsidies in Iran has changed household cost mechanisms and reduce non-subsidized food consumption, particularly among lower socioeconomic status. In this regard, it is stated that in the case of elastic goods such as food, due to a direct relationship between price and consumption, the increased price may significantly decrease the consumption {Sturm, 2010 #15}Some of these foods including milk, vegetables, and fruits have a significant effect on human health. So, applying required nutritional interventions such as allocation of subsidies (cash) on this group of food and prevention of raising their prices has a significant effect on individuals` nutritional behavior {Glanz, 2004 #6}.

Conclusion and Implications for Food Subsidy

Most researches of food subsidy programs are probably to focus on measures of nutritional intake as markers of improvement. Future nutrition intervention evaluations should use validated nutritional intake measures reported in a standardized format (e.g. repeated 24 hour recalls) to enable comparisons with other studies including a meta-analysis {Noar, 2007 #5}.Other economic analyses based on high-quality outcome studies would provide balancing data to help determine whether new or improved food subsidy program exemplify an effective asset within a country. An assessment of the Healthy program in the UK {Noar, 2007 #5}was limited by the ancient commitment to welfare food titles which prevented distribution using randomization. This will decrease the power of economic analyses based on such data. Modeling studies propose that healthy food subsidies in mixture with the taxation of unhealthy foods could have a more special effect on the nutrition of low-income people {Story, 2008 #4}.

According to the results of the studies discussed in this article, subsidies for healthy foods and taxes on unhealthy foods are beneficial in changing the diet of the community. The tax on unhealthy foods reduces the consumption of sodium, fat, and sugar from the general public and thus reduces the incidence of chronic diseases and reduces the burden of the cost of treatment of these diseases on the community. Socio-economic inequalities are a subject to be taken into account when applying subsidies or taxes on food. One study indicated that taking a meal and giving food subsidies improves the nutritional status of low-income families compared to the average population of the community (31). Tackling interventional policies for taxes and food subsidies requires the removal of poverty in society {Stemin, 2013 #3}.

Policy makers may consider policies that focus on improving the health of low-income earners. Studies analyzing what policies would be the most effective in improving health for low-income households, and the distributional effects of such policies, are therefore of interest (28). This study was directed according to the procedures recommended by the Cochrane Collaboration {Higgins, 2011 #2}.A perfect search plan and screening procedure make it is possible that related studies were identified. This article focused on studies with complete study designs, growing the likelihood that any positive properties could be attributed to the interventions {Lucas, 2008 #1}.This review has some noted limitations. The key factors to engage the food industry to embrace food subsidies/taxation remain relatively unexplored, and defining what foods are deemed or labeled as healthy or unhealthy continues to be a source of international debate.

Another limitation of this review was the difficulty in locating studies evaluating the effect on health outcomes over the long term, especially with respect to NCDs and comorbidities. Lastly, this search missed several articles, as the restricted nature of the search terms used in databases excluded studies that could have been included in the study. In a society like Iran, it is, necessary to identify government essential interventions and policies of population health improvement in order to reduce the risks and prevent undesired effects of targeting subsidies on the population health-related behavior. The government should further specify its goal of increasing food security to include increasing the use of high-quality foods, and offering subsidies for healthy food including F&V are recommended. Finally, the precise and comprehensive health impacts of subsidies on chronic disease and various physical and mental aspects remains unclear.

References

1. Organization WH. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. 2013.
2. Kheirouri S, Mohajeri M, Haghighian HK. Nitric oxide, omega-3 fatty acids and blood pressure in prinzmetal angina. Current Topics in Nutraceuticals Research. 2015;13(2):89.
3. Forouzanfar MH, Sepanlou SG, Shahraz S, BESc PN, Pourmalek F, Lozano R, et al. Evaluating causes of death and morbidity in Iran, global burden of diseases, injuries, and risk factors study 2010. Archives of Iranian medicine. 2014;17(5):304.
4. Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, de Silva P, Fuchs CS, et al. Long-term intake of dietary fat and risk of ulcerative colitis and Crohn9s disease. Gut. 2014;63(5):776-84.
5. Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. The Lancet. 2014;384(9937):45-52.
6. Di Noia J. Peer Reviewed: Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach. Preventing chronic disease. 2014;11.
7. Imamura F, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, et al. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. The Lancet Global Health. 2015;3(3):e132-e42.
8. Micha R, Khatibzadeh S, Shi P, Fahimi S, Lim S, Andrews KG, et al. Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys. Bmj. 2014;348:g2272.
9. Allison JC. Does Military Service Modify the Relationship between Race/Ethnicity and Diabetes and Hypertension Prevalence and Control? National Health and Nutrition Examination Survey (NHANES) 2007–2014 2017.
10. Bales CW, Starr KNP, Orenduff MC, McDonald SR, Molnar K, Jarman AK, et al. Influence of Protein Intake, Race, and Age on Responses to a Weight Reduction Intervention in Obese Women. Current Developments in Nutrition. 2017:cdn. 117.000703.
11. Spaeth AM, Dinges DF, Goel N. Sex and race differences in caloric intake during sleep restriction in healthy adults. The American journal of clinical nutrition. 2014;100(2):559-66.
12. Needham BL, Adler N, Gregorich S, Rehkopf D, Lin J, Blackburn EH, et al. Corrigendum to “Socioeconomic status, health behavior, and leukocyte telomere length in the National Health and Nutrition Examination Survey, 1999e2002”[Soc. Sci. Med. 85 (2013) 1e8]. Social Science & Medicine. 2015;133:101.
13. Niebylski ML, Redburn KA, Duhaney T, Campbell NR. Healthy food subsidies and unhealthy food taxation: A systematic review of the evidence. Nutrition. 2015;31(6):787-95.
14. 16. Afshin A, Penalvo J, Del Gobbo L, Kashaf M, Micha R, Morrish K, et al. CVD prevention through policy: a review of mass media, food/menu labeling, taxation/subsidies, built environment, school procurement, worksite wellness, and marketing standards to improve diet. Current cardiology reports. 2015;17(11):98.
15. Alagiyawanna A, Townsend N, Mytton O, Scarborough P, Roberts N, Rayner M. Studying the consumption and health outcomes of fiscal interventions (taxes and subsidies) on food and beverages in countries of different income classifications; a systematic review. BMC public health. 2015;15(1):887.

Don't let plagiarism ruin your grade

Run a free check or have your essay done for you

Check my essay Hire Writer