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Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income PeoplesDiscounts were implemented when randomised participants scanned theirpersonalised card at the checkout during the study intervention period. 1,104supermarket customers were randomised to one of four intervention arms: (1) tailorednutrition education, (2) price discounts, (3) a combination of discounts and education,or (4) a control group (no intervention). To our knowledge this is the only trial to dateto evaluate the effects of removal of GST on consumer shopping behaviour in a reallifesetting. The trial was completed in February 2009 and data analysis is currentlyunderway. Results are expected later this year.While SHOP examines strategies to improve population diet in general, and saturatedfat in particular, findings in relation to the impact of the price discount intervention onconsumer purchasing behaviour will nonetheless be informative regarding thepotential effectiveness of economic instruments to address food insecurity.Proposed Intervention Two: Smart Card discounts on foodpurchasesThe implication of the above discussion is that the proposed removal of GST on Food,or on ‘healthy nutritious foods’, such as fruit and vegetables, has significant problemsin terms of tax revenue losses, and in not directing resources to those householdsmost likely to be affected by food insecurity. Can the second proposed intervention dobetter on these criteria? The key magnitudes are the size of the proposed discount,and the size of the ‘target population’ who would be eligible for the proposed Smartcard. We pose below a set of questions about the coverage and targeting of a ‘SmartCard’, giving what seem plausible answers. More detailed research would be requiredshould the proposed intervention be taken further.Question One: What foodstuffs should be covered?On nutritional and distributional grounds, not all foodstuffs and non-alcoholicbeverages should be covered. It would seem undesirable to subsidise restaurantmeals and ready-to-eat foods, and non-milk beverages. Nor would it seem desirableto subsidise all meats, or grocery items in general. One possible conclusion is that anysubsidy should be confined to the fruit and vegetables sub-group, including frozen ordried fruit and vegetables, and also canned and bottled vegetables and fruit. It wouldbe generally well understood, by stores and the public, which items are fruit andvegetables l . Possible queries would be whether canned and bottled fruit should beincluded, whether ‘raw’ nuts should be added though not strictly part of the fruit andvegetables sub-group, and whether it is desirable to include ‘starchy’ root crops suchas potatoes, kumara, taro and yams. It seems simplest, administratively, to include allthese.Another option is to include other food items, such as milk, and cereals. Someoverseas programmes include such items. For instance, the Healthy Start programmein the UK provides low-income pregnant women or women with children under fourwith vouchers of GBP3.00 per week for purchase of milk, fresh fruit, fresh vegetablesand infant formula milk. As discussed earlier in this chapter, a good part of ‘foodinsecurity’ relates to consumption of ‘staples’ such as milk and cerealsl However the SHOP research team have found it not quite so simple. A number of items were difficultto classify, such as stir fry vegetable with sauces, strawberries with chocolate dips, fruit juice with lessthan 100 percent juice, etc. This was a major reason for the decision to use a nutrient profiling system inthe trial.21
Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income PeoplesAs noted earlier, average weekly household expenditure on fruit and vegetables in2006/07 amounted to $18.40. Average weekly household expenditures in that year onselected other products were: fresh milk $4.60, bread $5.50, breakfast cereals $1.90,and grains $0.60. Such items could clearly be included in the coverage of a SmartCard or voucher programme, though probably with some difficulties in deciding whichcereals and cereal products should qualify m .A third option, as discussed earlier in this chapter, would be to include all itemspassing a ‘nutritional quality’ test. For example, the proposed nutritional profilingscheme proposed by FSANZ to determine the eligibility of foods to carry health claimsQuestion Two: Should the subsidy apply to all food purchases by any person?No. The reasons for this answer are the same as those given above for not removingGST from fruit and vegetables. Namely the fiscal cost, and the inadequacy of ageneral subsidy in targeting assistance at those households most likely to be sufferingFood Insecurity.Question Three: Who then should receive the discounts?There are several possibilities, including the following:(1) Beneficiary households, excluding pensioner households.That is, households receiving one of the ‘main benefits’ – unemployment, domesticpurposes, sickness, and invalid’s benefits, and some others less important. Thenumber of working-aged (18-64) individuals receiving such benefits totalled 286,176 inDecember 2008 (Ministry of Social Development web-site). The number of childrendependent on working aged recipients of a main benefit was 205,324 in June 2007. 21A possibility here would be trading off a reduction in the benefit cash payment for anincrease in the discount made available. Arguments against using beneficiary statusas the criterion for eligibility are that it is ‘stigmatising’, and that while somehouseholds suffering ‘food insecurity’ will certainly be beneficiary households, it isequally certainly not the case that all households suffering ‘food insecurity’ arebeneficiary households.(2) Community Services Card (CSC) holders, excluding pensioners.Cards are issued to adults who are members of families with family income below aspecified level. They have in the past mainly served to qualify holders for primaryhealth-care subsidies, covering perhaps up to 40 percent of the population. CSCholdersnumbered 924,092 at end-June 2007. Deducting NZ Superannuationrecipients (ie. ’pensioners’) numbering 272,171 gives a remainder of 651,921.Arguments against CSC-holding as the eligibility criterion are that ‘take-up’ of the cardis thought to be poor for some groups, the more so in recent years as primary healthcare has become more heavily subsidised and the advantages from card-holding less.(3) Households with dependent children.These numbered, in HES 2006/07, in thousands:Couple with one dependent child 130.3Couple with two dependent children 149.0Couple with three or more dependent children 76.9One parent with dependent child(ren) only 90.3The total is 446,500 plus, in addition, some more complex households with dependentchildren. An approximate estimate suggests the above households would have aboutm Again an argument for a ‘nutrient profiling’ approach.22
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