Role of food prices and food system changes in improving population health
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Public Health and Policy
Abstract
AE1: Food and diet related health AE2: Epidemiological and population health studies AE3: Health economics and economic evaluations AE4: Impact of prices on population behaviour
Technical Summary
The CDA research programme uses advanced econometric methods to develop models and analyse dietary behaviour via food and beverage demand and linking to health outcomes by addressing four key gaps in current research:
RQ1: What is the role of stock-piling (storing), habits and information asymmetry in influencing consumer response to price changes and the choice of foods and beverages?
RQ2: What is the role of out-of-home food and beverage consumption in diets, and how does the demand for OOH foods and beverages respond to price changes, including substitution with foods eaten at home?
RQ3: What is the impact of industry-led voluntary changes in food systems, to achieve healthier food environments, on consumer food and beverage choices and expenditures?
RQ4: How can Discrete Choice Experiments (DCE) be effectively used in analysing the impact of food policies on consumer behaviour in the context of large numbers of alternatives and multiple choices?
RQs1-3 will be answered by micro-econometric analysis of highly disaggregated longitudinal panel data on household food and beverage purchases. Planned methods range from discrete choice models (RQ1) and multi-stage demand systems (e.g. almost ideal demand system) (RQ1-2) to interrupted time series designs with control groups and multi-level hierarchical random effects models (RQ3). For RQ4, advanced DCE methods will be used, including Bayesian D-efficient designs, and allowing for large number of alternatives and multiple choices via menu based experiments or multiple discrete choice models.
Two major innovations from the proposed programme include the use of newly available and highly disaggregated data for food and beverage consumption outside homes that will be linked to at-home consumption data, and an application of the DCE in the same sample meaning that stated preferences can be put into context with wider behaviour using large amounts of highly disaggregated observed behaviour (preference) data.
RQ1: What is the role of stock-piling (storing), habits and information asymmetry in influencing consumer response to price changes and the choice of foods and beverages?
RQ2: What is the role of out-of-home food and beverage consumption in diets, and how does the demand for OOH foods and beverages respond to price changes, including substitution with foods eaten at home?
RQ3: What is the impact of industry-led voluntary changes in food systems, to achieve healthier food environments, on consumer food and beverage choices and expenditures?
RQ4: How can Discrete Choice Experiments (DCE) be effectively used in analysing the impact of food policies on consumer behaviour in the context of large numbers of alternatives and multiple choices?
RQs1-3 will be answered by micro-econometric analysis of highly disaggregated longitudinal panel data on household food and beverage purchases. Planned methods range from discrete choice models (RQ1) and multi-stage demand systems (e.g. almost ideal demand system) (RQ1-2) to interrupted time series designs with control groups and multi-level hierarchical random effects models (RQ3). For RQ4, advanced DCE methods will be used, including Bayesian D-efficient designs, and allowing for large number of alternatives and multiple choices via menu based experiments or multiple discrete choice models.
Two major innovations from the proposed programme include the use of newly available and highly disaggregated data for food and beverage consumption outside homes that will be linked to at-home consumption data, and an application of the DCE in the same sample meaning that stated preferences can be put into context with wider behaviour using large amounts of highly disaggregated observed behaviour (preference) data.
Planned Impact
The research proposed has a number of beneficiaries:
The research team. The PI will gain further knowledge, skills and experience to evolve from an independent researcher to a clear leader in the field. The CDA allows hiring a research fellow and thus supporting career development of a junior public health economist.
LSHTM. LSHTM will benefit from this research through a more diversified research portfolio, and high-quality research outputs in a strategically important area in public health research globally.
Academia. This research will introduce novel insights into households' dietary behaviour by analysing a novel and largely unused data on food and beverage consumption patterns both at-home and out-of-home. The benefit from the research is providing input into future research from using the findings or via developed methods and statistical applications.
Health policy makers. The project aims to provide evidence-based answers that help in deciding on and/or designing policies to influence food or beverage consumption habits. The scientific papers and other output (e.g. policy briefs) from the project will therefore include clearly written policy suggestions that health policy makers can benefit from.
Civil society organisations, professional bodies, health charities, lobby groups and other interest groups who wish to influence health policy regarding reductions in obesity and NCDs. These groups will benefit as their work can be based on peer-reviewed and published research findings as well as via continuous links with the PI and her emerging team to also provide input via suggestions and recommendations to research.
Ultimately the beneficiaries of this research are the people whose health and life quality can be improved by effective policies to reduce obesity and NCD prevalence rates. Healthier people mean a healthier workforce and thus savings from firm to national level from lower medical costs and reduced work absence will eventually boost economic growth for the country. Furthermore, resources saved from lower prevalence of obesity and NCDs can be used elsewhere to improve other public services.
In the longer run it is not just the UK and developed countries that benefit but also developing countries where the growing issue of double burden of disease means that these governments will be seeking effective solutions including these tested in developed countries.
The research team. The PI will gain further knowledge, skills and experience to evolve from an independent researcher to a clear leader in the field. The CDA allows hiring a research fellow and thus supporting career development of a junior public health economist.
LSHTM. LSHTM will benefit from this research through a more diversified research portfolio, and high-quality research outputs in a strategically important area in public health research globally.
Academia. This research will introduce novel insights into households' dietary behaviour by analysing a novel and largely unused data on food and beverage consumption patterns both at-home and out-of-home. The benefit from the research is providing input into future research from using the findings or via developed methods and statistical applications.
Health policy makers. The project aims to provide evidence-based answers that help in deciding on and/or designing policies to influence food or beverage consumption habits. The scientific papers and other output (e.g. policy briefs) from the project will therefore include clearly written policy suggestions that health policy makers can benefit from.
Civil society organisations, professional bodies, health charities, lobby groups and other interest groups who wish to influence health policy regarding reductions in obesity and NCDs. These groups will benefit as their work can be based on peer-reviewed and published research findings as well as via continuous links with the PI and her emerging team to also provide input via suggestions and recommendations to research.
Ultimately the beneficiaries of this research are the people whose health and life quality can be improved by effective policies to reduce obesity and NCD prevalence rates. Healthier people mean a healthier workforce and thus savings from firm to national level from lower medical costs and reduced work absence will eventually boost economic growth for the country. Furthermore, resources saved from lower prevalence of obesity and NCDs can be used elsewhere to improve other public services.
In the longer run it is not just the UK and developed countries that benefit but also developing countries where the growing issue of double burden of disease means that these governments will be seeking effective solutions including these tested in developed countries.
Organisations
- London School of Hygiene & Tropical Medicine (Fellow, Lead Research Organisation)
- PUBLIC HEALTH ENGLAND (Collaboration)
- London School of Hygiene and Tropical Medicine (LSHTM) (Collaboration)
- Erasmus University Rotterdam (Collaboration)
- UNIVERSITY OF EXETER (Collaboration)
- University of Bologna (Collaboration)
- University of Illinois at Chicago (Collaboration)
Publications
Watt TL
(2020)
Reducing consumption of unhealthy foods and beverages through banning price promotions: what is the evidence and will it work?
in Public health nutrition
Watt T
(2023)
The impact of price promotions on sales of unhealthy food and drink products in British retail stores.
in Health economics
Scheelbeek PFD
(2019)
Potential impact on prevalence of obesity in the UK of a 20% price increase in high sugar snacks: modelling study.
in BMJ (Clinical research ed.)
Law C
(2020)
The impact of UK soft drinks industry levy on manufacturers' domestic turnover.
in Economics and human biology
Law C
(2020)
An analysis of the stock market reaction to the announcements of the UK Soft Drinks Industry Levy.
in Economics and human biology
Law C
(2022)
Place matters: Out-of-home demand for food and beverages in Great Britain
in Food Policy
Kalbus A
(2023)
Associations between the food environment and food and drink purchasing using large-scale commercial purchasing data: a cross-sectional study.
in BMC public health
Faccioli M
(2022)
Combined carbon and health taxes outperform single-purpose information or fiscal measures in designing sustainable food policies
in Nature Food
Cummins S
(2020)
COVID-19: impact on the urban food retail system and dietary inequalities in the UK
in Cities & Health
Cuevas S
(2021)
Escaping the Red Queen: Health as a corporate food marketing strategy.
in SSM - population health
Coutrot IP
(2020)
Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care?
in Journal of health services research & policy
Cornelsen L
(2019)
Socio-economic patterning of expenditures on 'out-of-home' food and non-alcoholic beverages by product and place of purchase in Britain.
in Social science & medicine (1982)
Cornelsen L
(2023)
Policy Vs Business: Well-Designed Health-Related Food Policy Should Not Let Industry Marketing Undermine Its Intended Effects; Comment on "Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019"
in International Journal of Health Policy and Management
Cornelsen L
(2018)
Viewpoint: Soda taxes - Four questions economists need to address
in Food Policy
Cornelsen L
(2019)
Fat tax or thin subsidy? How price increases and decreases affect the energy and nutrient content of food and beverage purchases in Great Britain.
in Social science & medicine (1982)
Berger N
(2020)
Patterns of beverage purchases amongst British households: a latent class analysis
in European Journal of Public Health
Berger N
(2021)
Have socio-economic inequalities in sugar purchasing widened? A longitudinal analysis of food and beverage consumer data from British households, 2014-2017.
in Public health nutrition
Berger N
(2019)
Recent trends in energy and nutrient content of take-home food and beverage purchases in Great Britain: an analysis of 225 million food and beverage purchases over 6 years
in BMJ Nutrition, Prevention & Health
| Description | FSA expert reviewer |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | HFSS ban on multi-buy promotion consultation |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| Description | Henry Trial Steering Group member |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | COPPER: CO-designing for healthy People and Planet: food Economic policy Research |
| Amount | £1,450,095 (GBP) |
| Organisation | National Institute for Health Research |
| Sector | Public |
| Country | United Kingdom |
| Start | 05/2022 |
| End | 06/2025 |
| Description | Evaluation of the health impacts of the UK Treasury Soft Drinks Industry Levy (SDIL) |
| Amount | £1,498,956 (GBP) |
| Funding ID | PHR/16/130/01 |
| Organisation | National Institute for Health Research |
| Sector | Public |
| Country | United Kingdom |
| Start | 07/2017 |
| End | 12/2021 |
| Description | Evaluation of the removal of HFSS 'junk-food' advertising in public transport networks on junk-food awareness and purchasing in London: natural experiment study |
| Amount | £250,000 (GBP) |
| Organisation | National Institute for Health Research |
| Sector | Public |
| Country | United Kingdom |
| Start | 04/2019 |
| End | 03/2021 |
| Description | Food purchasing, food environments and the COVID-19 pandemic in England: Exploration of associations using large-scale secondary data |
| Amount | £77,000 (GBP) |
| Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 09/2018 |
| End | 04/2023 |
| Description | Impact of changes in the food environment on food and drink purchasing using large-scale secondary data |
| Amount | £60,000 (GBP) |
| Organisation | Bloomsbury Colleges |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 09/2019 |
| End | 08/2022 |
| Description | Market Solutions to Childhood Obesity |
| Amount | £20,000 (GBP) |
| Organisation | Guy’s & St Thomas’ Charity |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 05/2018 |
| End | 08/2018 |
| Description | PHP EARLY CAREER FELLOWSHIP |
| Amount | £14,500 (GBP) |
| Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 02/2020 |
| End | 05/2020 |
| Description | School of Public Health Research at LSHTM |
| Amount | £5,000,000 (GBP) |
| Organisation | National Institute for Health Research |
| Sector | Public |
| Country | United Kingdom |
| Start | 04/2022 |
| End | 03/2027 |
| Description | Sustainable and Healthy Food Systems |
| Amount | £5,000,000 (GBP) |
| Organisation | Wellcome Trust |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 07/2017 |
| End | 05/2022 |
| Description | Understanding the association between use of digital food delivery services and household food purchasing behaviours |
| Amount | £117,186 (GBP) |
| Organisation | National Institute for Health Research |
| Sector | Public |
| Country | United Kingdom |
| Start | 05/2021 |
| End | 04/2022 |
| Description | Collaboration with Erasmus University Choice Modelling Centre |
| Organisation | Erasmus University Rotterdam |
| Department | Institute of Health Policy & Management (iBMG) |
| Country | Netherlands |
| Sector | Academic/University |
| PI Contribution | We initiated this collaboration to carry out a choice experiment on the impact of calorie labelling of takeaway foods in online settings. LSHTM will lead the design, conduct and analysis of the study |
| Collaborator Contribution | To provide input into the design and analysis of the experiment as well as contribution to written output |
| Impact | Study protocol draft |
| Start Year | 2021 |
| Description | Collaboration with Lisa Powell |
| Organisation | University of Illinois at Chicago |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | I visited Lisa Powell from UIC for a 2 week period to discuss mutual interests and projects. I agreed to help advise a PhD student at UIC and contributed to a conference submission. |
| Collaborator Contribution | - advice on specific papers - initial agreements on working jointly towards publication |
| Impact | joint session at International Conference on Behavioural Nutrition and Physical Activity |
| Start Year | 2018 |
| Description | Collaboration with Mario Mazzocchi |
| Organisation | University of Bologna |
| Department | Department of Statistics |
| Country | Italy |
| Sector | Academic/University |
| PI Contribution | Mario is helping me with my fellowship project. |
| Collaborator Contribution | Mario is helping me with the development of the model for measuring asymmetries in consumer demand. We jointly author publications (in progress). He has made 2 research visits to London. I have made two research visits to Bologna University. The collaboration is extended now with a postdoc working with Mario (Sara Capacci) |
| Impact | Presentation at Schumpeter School Award (June 2015) (by M. Mazzocchi) Presentation at iHEA Congress in Milan (July 2015) (by L.Cornelsen) Presentation at HESG Meeting in Manchester (January 2016) (by L.Cornelsen) Two academic papers , currently under review with journals; invited seminar at the University of Cornell (April 2017) |
| Start Year | 2014 |
| Description | DrPH Supervision of Rachel Clark |
| Organisation | Public Health England |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | provide statistical guidance and general supervision |
| Collaborator Contribution | provide funding for the degree and data |
| Impact | no output yet |
| Start Year | 2019 |
| Description | PhD supervision of Omotomilola Ajetunmobi |
| Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
| Department | Faculty of Public Health and Policy |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Co-supervision of a PhD titled The impact of migration on local (UK) food systems - opportunities and challenges for public health |
| Collaborator Contribution | The partner will do field work and analyse data |
| Impact | outputs awaiting This is a mixed method project: involving quantitative researchers and qualitative researchers (including ethnographic work) |
| Start Year | 2018 |
| Description | Phd supervision Alexandra Kalbus |
| Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Supervision |
| Collaborator Contribution | Work conducted in field highly relevant to the fellowship |
| Impact | article draft, conference presentation |
| Start Year | 2018 |
| Description | collaboration with Richard Smith and Ian Bateman |
| Organisation | University of Exeter |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | conduct analyses and advise on analyses to conduct |
| Collaborator Contribution | literature review, will conduct a survey; obtained funding for a survey |
| Impact | no impact yet |
| Start Year | 2019 |
| Description | Contact with DHSC regarding calorie labelling |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Chat with DHSC analysts regarding calorie labelling and possible engagement. This led to further contacts/opportunites (e.g. data availabiltiy) exchanged |
| Year(s) Of Engagement Activity | 2022 |
| Description | ESRC workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Invited talk at ESRC funded workshop on health information |
| Year(s) Of Engagement Activity | 2018 |
| Description | EUHEA presentation "Out of sight, out of mind? Impact of healthy checkout policies on energy purchases from chocolate and sugar confectionary in supermarkets" |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | EUHEA presentation "Out of sight, out of mind? Impact of healthy checkout policies on energy purchases from chocolate and sugar confectionary in supermarkets". presentation led to conversation with other researchers from Germany and France |
| Year(s) Of Engagement Activity | 2021 |
| Description | Engagement with young people from Camden |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Schools |
| Results and Impact | Presentation of food related policies to young people from Camden (invitation from Dalya Marks) |
| Year(s) Of Engagement Activity | 2022 |
| Description | FT interview on BJ comments on sugar tax |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Interview to FT on BJ comments about sugar tax |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://www.ft.com/content/5b53a8c6-9d77-11e9-b8ce-8b459ed04726 |
| Description | Global Food Security Lab |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Other audiences |
| Results and Impact | Presentation on economic drivers of food choice to GFS lab for early career researchers on healthy and sustainable diets |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://www.foodsecurity.ac.uk/news/180105-n-ecr-policy-lab-determinants-food-choice-healthy-sustain... |
| Description | HESG leeds |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Other audiences |
| Results and Impact | 20-30 people attended a presentation on the cost of healthy food analysis |
| Year(s) Of Engagement Activity | 2022 |
| Description | Interview for Malnutrition Deeply |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Interview panellist on fiscal policies on sugary drinks |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://www.newsdeeply.com/malnutrition/articles/2018/01/26/taxing-the-world-out-of-obesity |
| Description | Interview to Wired UK on BJ comments |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Wired UK interview |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://www.wired.co.uk/article/boris-johnson-sin-tax-sugar-tax |
| Description | Italian press interview |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Interview to italian newspaper Manifesto |
| Year(s) Of Engagement Activity | 2019 |
| Description | Launch of Healthy Returns report |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Industry/Business |
| Results and Impact | Healthy Returns report launch; some follow up contact into using data to come up with new products to promote healthy eating |
| Year(s) Of Engagement Activity | 2018 |
| Description | PHI|lab blog posts |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Blog posts published on our research group website. The blog posts present results from our published worked in plain language and target a general informed audience. The website receives about 100 visits every month. |
| Year(s) Of Engagement Activity | 2019,2020 |
| URL | https://philab.lshtm.ac.uk/news/ |
| Description | Presentation at Pre-Cop24 conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Third sector organisations |
| Results and Impact | Invited talk on the successes of SSB taxes |
| Year(s) Of Engagement Activity | 2018 |
| Description | Sciensano (Beglium) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presentation on the calorie labelling experiment to Sciensano (National public health institute in Belgium) Nutrition and Health team |
| Year(s) Of Engagement Activity | 2023 |
| Description | Talk to Liberal Democrats working group on food policies |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | A presentation and discussion to Liberal Democrats working group on future food policies for sustainable food system in the UK |
| Year(s) Of Engagement Activity | 2022 |
| Description | World Heart Federation panel |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | panel talk about food taxes and subsidies |
| Year(s) Of Engagement Activity | 2021 |
| Description | invited seminar at Reading |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | Invited lunchtime departmental (dep. of Agriculture) seminar at the University of Reading where I presented work on the discrete choice experiments. |
| Year(s) Of Engagement Activity | 2018 |
| Description | press release on Plos Med paper on beverage patterns |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Press release on beverage pattern paper. Picked-up by a few outlets |
| Year(s) Of Engagement Activity | 2020 |
| Description | press release on sweet tax |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Press release on sweet tax paper, picked up by 18 news outlets (altmetric 577) |
| Year(s) Of Engagement Activity | 2019 |
| Description | school website |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | News story on fellowhsip on LSHTM news website |
| Year(s) Of Engagement Activity | 2017 |
| URL | https://www.lshtm.ac.uk/newsevents/news/2017/ps1-million-help-shape-policies-tackle-diet-related-non... |