NT Nutritionist's Market Basket Survey.

Food Security, a huge issue affecting remote Aboriginal communities.

More than 50 years ago, on the 10th December 1948, the General Assembly of the UN adopted the Universal Declaration of Human Rights. In it, Article 25 states that:

"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control." (1)

In short, access to a healthy food supply has been deemed a fundamental human right, something we all have a right to expect will be made available to us by the mechanisms of the society in which we live.

The Dietary Guidelines for Adults in Australia 2003 advise us how to properly utilise our (presumably) healthy food supply. At the top of the list is advice to:

"Enjoy a wide variety of nutritious foods

  • Eat plenty of vegetables, legumes and fruits" (2).

The promise is that if we have our human rights to a healthy food supply intact, and if we utilise our food supply in a healthy way (by eating plenty of vegetables, legumes and fruits), most of us will live a long and healthy life, and be free of nutrition related diseases.

In remote areas of Australia however, many people’s ability to "eat plenty of vegetables, legumes and fruits" depends on how easily they can access healthy affordable food, that is, how "Food Secure" they are.

Food Security means that "resources are used efficiently, equitably, and sustainably to ensure the accessibility and availability of nutritionally adequate and culturally acceptable food for all people by socially acceptable means" (3).

Unfortunately, resources that could ensure food security in remote communities of are not used efficiently, equitably or substainably. While employed and salaried people in the regional centres of Australia have access a wide range of relatively affordable fresh fruit and vegetables, the poorest people in Australia, Aboriginal people, face the highest prices for healthy food, have a limited range of healthy foods available to them, and suffer enormously from nutrition related diseases.

Poor food supply is a barrier to good nutrition and health, especially in remote Aboriginal communities. Nutrition related chronic diseases such as diabetes and heart disease contribute to the lower life expectation of Aboriginal and Torres Straits Islander people throughout Australia. Healthy food is essential both to prevent these conditions and to manage them. Poor nutrition also contributes to the high levels of infectious diseases and poor growth in children, increasing their susceptibility in adult life (4).

In the NT alone, nutrition related disease costs somewhere between 1/5th and 1/3rd of the total NT budget annually (6). In recognition of this enormous impost on the public purse, NT Nutritionists have conducted a Market Basket Survey annually since 1998 to measure and monitor the food supply in remote communities, and hopefully influence its improvement. The survey, typically conducted between April and July, measures and compares the availability, variety, quality and affordability of healthy food for families shopping at Aboriginal community stores, and compares costs with the food supply available to families shopping at district centre stores.

 

The need for a measuring instrument

Many methods have been tried to influence cost, quality and variety of foods available in remote community stores. Store turnover method, blah blah blah.  Best tool to measure change was developed by former Katherine nutritionist. However, no standardised tool or method used over NT so that results could be compared.

Interstate market basket surveys didn't measure quality or variety to sufficient extent to meet NT needs. Need to develop our own to meet our requirements for monitoring and surveillance. Work can be shared with Queensland and WA with the possibility of using the same method across the north of Australia.

 

Other measuring instruments/survey tools

Kimberley Market Basket Survey (KMBS)

The KMBS was developed in the 1970's by Helen Sullivan and Michael Gracey in response to the high rates of Failure To Thrive in the Kimberley. It was considered that if healthy food could be made affordable then children in the Kimberley would be fed better and there would be fewer cases of Failure To Thrive.

Characteristics

The KMBS is based on the average turnover of Kimberley Aboriginal Community stores. The basket supplies the "needs' of a hypothetical family of 5. The needs are based on energy requirements for a family of five.

Limitations

No attempt is made to cost a nutritionally balanced basket of foods. The cost to a family of 5 to maintain weight is estimated but the cost of meeting minimal nutrient requirements is not costed.

The survey does not measure quality of the foods in the store nor variety of the foods available other than to record the foods in the survey as being available)

Katherine District Market Basket Survey

Characteristics

Limitations

The desired characteristics of a suitable survey instrument

According to NT nutritionists a desirable survey should have the following attributes:

  1. be able to cost a basket of foods which would meet the minimal energy and nutrient requirements of a typical family for a given time period
  2. be able to compare the cost of the basket of foods purchased in a remote Aboriginal community with duplicate basket purchased at a store or supermarket in town
  3. be able to measure the quality the variety of foods available in the stores
  4. be able to, if conducted on an annual or biannual basis, measure the effectiveness of nutritionists activities in community nutrition
  5. be able to cost some "healthware" items such as soap, clothes washing detergent, disposable nappies which are essential for maintaining health, and
  6. be able to cost tobacco and cigarettes, items which tend to consume a large quantity of available money in Aboriginal communities.
Development of "The Basket"

The basket was developed with the above desirable characteristics in mind.

  • Whom will "The Basket" feed? The Hypothetical Family of Six.

Early in the consultation phase for the development of the NT Food Policy 1996 - 2001, a meeting of the Aboriginal Advisory group proposed that the basket should cost the "needs" of a family.  A "hypothetical" family of 6 people was proposed with the following characteristics:

  • an adult couple
  • a teenage son
  • a female child older than 5 years
  • a male child under 5 years
  • a grandmother aged over 54 years

The Core Food Groups (Ref) and the essential nutrient requirements (NH&MRC) for the family were used to develop a healthy basket of foods that would meet the nutrient and energy needs of the family for 14 days. This process is outlined below.

  • Determination of "The Family's" Core Food requirements

The Core Food requirements for the family was determined from a composite from Table B in the Core Food Recommendations. The middle of the road was deemed to be the most reasonable to follow. Although the high fat one was more like what people eat in Aboriginal communities it was decided that to cost a diet like that would underestimate the cost of a healthy diet?? The low fat choice was deemed to be too much unlike what people eat or could possibly attain. Thus a compromise was made and the middle of the road was chosen

The family's core food requirements was determined as follows:

Table x:  blah de blah de blah

  Male 4-7yrs Female 8-11yrs Male 12 - 15 Male 19+ Female 19 - 54 Female 54+ Family Daily Total Family 14 day core food requirements
Cereal, expressed as weight of bread (g) 120 150 180 210 210 210 1,080 15,120
Fruit, based on edible portion (g) 150 150 300 300 300 300 1,500 21,000
Vegetables, cooked weights (g) 150 225 300 300 300 300 1,575 22,050
Meat, cooked weights (g) 35 65 85 85 85 85 440 6,160
Milk, expressed as mL milk 400 450 550 450 450 450 2,750 38,500

The Core Food Recommendations are designed to determine individual food requirements to provide 70% of essential nutrients and only 53% of energy requirements. It was considered by the steering committee that using the Core Food Recommendations unaltered had the potential to underestimate the cost of maintaining the nutritional status of the group and maintain current weight of a group.

The Core Food Recommendations state that about 53% of energy needs will be met by core foods if they meet 70% nutrient requirements. Therefore, considering that we are determining the cost of maintaining nutritional status of a group it was considered necessary to increase the amount of food coming from the Core Food Groups to provide 100% of nutrients. This was achieved simply by multiplying each of the core food requirements by the factor of 1.43 (100/70) so that 100% of nutrients could be provided.

Doing this would increase energy provided by the core foods from 53% to 75%. This was also considered to underestimate the cost of maintaining weight for the family. The steering committee that it was appropriate to add fat and sugar to the core foods to provide another 20% of the family energy requirements to provide a total of 95% of energy. This was deemed appropriate as it has been determined by Lee that between 3 to 6% of energy is derived from bush foods.

Table x blah de blah de blah

  Family 14 day Core Food requirements 
(provides 53% Energy and 70% or more of nutrients) 
Family 14 day Core Food requirements 
(provides 75% Energy and 100% or more of nutrients)
Cereals, expressed as weight of bread (g)  15,120 21,600
Fruit, based on edible portion (g) 21,000 30,000
Vegetables, cooked weights (g) 22,050 31,500
Meat, cooked weights (g) 6,160 8,800
Milk, expressed as mL milk 38,500 55,000

 

  • Choosing Core Foods to meet Core Food requirements

Experienced nutritionists were surveyed about which foods in each of the Core Food groups were available in remote Aboriginal community stores.  A list of foods was drawn up that were relatively healthy, commonly available, likely to be eaten on a regular basis and, if eating in proportions recommended by health authorities, would contribute to the consumption of a healthy balanced diet.

Experienced nutritionist's opinion was also sought as to what proportion of each core food group should be made up of each food. This led to lengthy debate because the consumption of (for example) staples such as bread, rice and flour (in the form of damper) varies from region to region.  Eventually the steering committee of nutritionists decided that the basket should have all three foods in it, but that the larger proportion of food in this group should come from sliced bread.  In the end many compromises were made to include foods which were commonly eaten but the basket, in order to determine the cost of a healthy diet which meets the energy and nutrient needs of a family, does not necessarily reflect the eating pattens of the community for whom it was designed, especially in the case of fruit and vegetables.  If it did, we would be calculating the cost of an unhealthy diet, and this was not the objective of the survey.  

Foods from each group were converted to Core Food group "equivalents" using energy as a guide for equivalence. Foods were added in the proportions recommended to the food group until the Core Food Requirements for the family were met. Percent edible portion was accounted for in the calculations.

Bread and Cereals Weight food required (grams) Conversion factor to 30g bread equivalent Bread gram equivalents provided by weight of food
Flour 4000 20 6000
Bread 9520 30 9520
Breakfast biscuit (Weetbix, Vitabrits) 1000 25 1200
Rolled Oats 1000 20 1500
Spaghetti in Tomato Sauce 2975 125 714
      20134
      93%

 

Fruit Weight food required (grams) Percent edible portion of fruit Fruit gram equivalents provided by weight of food
Apples
(Ave apple 150g)
7500 92% 6900
Oranges 7975 74% 5902
Bananas 6820 62% 4228
Canned Peaches 3080 ? 70% 2156
    Conversion factor
to 145g orange
 
Orange Juice 7000 115 8825
      28012
      93%

 

Vegetables Weight food required (grams) Percent edible portion of vegetable Vegetable gram equivalents provided by weight of food
Potato 8000 82% 6560
Onions 3000 88% 2640
Carrots 4000 90% 3600
Cabbage 3000 81% 2430
Pumpkin 3000 80% 2400
Fresh Tomatoes 2000 99% 1980
Canned Tomatoes 2490 100% 2490
Canned Peas 2940 ? 70% 2058
Canned Beans 3080 ? 70% 2156
Baked Beans 2975 100% 2975
      29,289
      93%

 

Meat and Alternatives Weight food required (grams) Percent edible portion of meat equivalent Meat gram equivalents provided by weight of food
Canned Corned Beef 2380 100% 2380
Canned Meat and Vegetables 3150 100% 3150
Eggs 660 88% 581
    Original weight minus cooking shrinkage  
Fresh/Frozen boneless
beef/mutton
1500 80% 1200
Boneless Chicken 1000 80% 800
      8111
      92%

 

Milk Weight food required (grams) Conversion factor to 250mL milk Milk mL equivalents provided by weight of food
Full Cream Milk Powder* 7000 37.5 46,667
Cheddar Cheese* 750 37.5 5,000
      51,667
      94%

* conversion factor for milk to dairy products was determined from number of calories

Non Core Foods Weight food required (grams) Kilojoules provided % energy needs for the family*
Margarine 2,000 60,200 8.3%
Sugar 4,500 72,000 10%

* the total number of calories required by the family is show in table below

  • Ensuring that the basket chosen from core foods meets the energy and nutrient needs of the family

Firstly the theoretical nutrient requirements of the family were determined using the NH&MRC guidelines, as illustrated in the following table:

Nutrient Dad Mum 4 year old male 8 year old female 14 year old male granny 1 day composite for family 14 day composite for family units
b Carotene Eq 750 750 350 500 725 750 3825 53,550 ug
Calcium 800 800 800 900 1200 1000 5500 77,000 mg
Fibre 30 30 0 0 30 30 120 1,680 g
Iron 7 12 6 6 10 5 46 644 mg
Magnesium 320 270 110 160 260 270 1390 19,460 mg
Niacin Eq 19 13 12 15 20 11 90 1,260 mg
Phosphorous 1000 1000 700 800 1200 1000 5700 79,800 mg
Potassium 1950 1950 1560 1950 1950 1950 11310 158,340 mg
Protein 55 45 18 27 42 45 232 3,248 g
Riboflavin 1.7 1.2 1.1 1.3 1.8 1 8.1 113.4 mg
Sodium* 2300 2300 1730 2300 2300 2300 13230 185,220 mg
Thiamin 1.1 0.8 0.7 0.8 1.2 0.7 5.3 74.2 mg
Total Kilojoules 10500 8300 7100 7700 11200 6900 51700 723,800 kJ
Vitamin C 40 30 30 30 30 30 190 2660 mg
Zinc 12 12 6 9 12 12 63 882 mg

*Requirements for sodium were determined from summation of the individual upper limits for sodium for the "family".

The using the above method to determine the amount of core foods the basket provided 70% or more of nutrient requirements (zinc being the limiting nutrient) and 53% of energy.

This was subsequently reviewed at a later date. This is discussed in more detail below under the heading of Modifications to the Basket

Analysis of the Family Basket provided the following nutrients. This was done by analysing the foods in the basket to ensure that they meet the needs of the family. This was done using SERVE which uses the NUTTAB95 database.

Nutrient Units Family Basket for 14 days provides: Amount nutrient required (see table x above) Percent nutrient needs met
b Carotene Eq ug 586,066 53,550 1094%
Calcium mg 97,775 77,000 127%
Fibre g 2,185 1,680 130%
Iron mg 883 644 137%
Magnesium mg 23,160 19,460 119%
Niacin Eq mg 2,266 1,260 180%
Phosphorous mg 134,006 79,800 168%
Potassium mg 278,001 158,340 176%
Protein g 6,177 3,248 190%
Riboflavin mg 178 113.4 157%
Sodium* mg 209,304 185,220 113%
Thiamin mg 129 74.2 174%
Total Kilojoules kJ 687,274 723,800 95%
Vitamin C mg 14,261 2,660 536%
Zinc mg

878

882 100%

*Requirements for sodium were determined from summation of the individual upper limits for sodium for each member of "the family".

Thus the family basket provides 95% energy requirements and 100% or more of nutrient requirements (with zinc as the limiting nutrient). The basket then represents the basic food requirements for a family of six for 14 days.

Other measures of adequacy of the family basket include nutrient density and proportions of energy by macronutrients to the total energy. These are outlined below.

In summary

The family basket provides 95% energy requirements and 100% or more of nutrient requirements (with zinc as the limiting nutrient). This hypothetical basket for a hypothetical family of 6 people can be used to represent their basic requirements for 14 days. Costing this basket in stores enables us to determine the cost to a family of six to purchase enough healthy food to, in the absence of disease, maintain nutritional status and weight indefinitely.

As the proportions of foods in the basket were determined arbitrarily it may be necessary to review these proportions at some later date. Nevertheless, the actual foods in the basket are considered to represent many of the Core Foods eaten by people living in remote communities of the NT. If it was decided to modify the proportions of individual foods in the basket this could be achieved with little difficulty for current or past surveys.

 

 The NT Nutritionists Market Basket Survey 1998
The Aim of the Survey:
  • to measure, compare and monitor the quality, variety and cost of healthy foods in remote Aboriginal community stores in the Northern Territory (NT) of Australia
  • to monitor the effectiveness of nutritionist's activities in rural and remote Aboriginal community stores in the NT
  • to bring about an improvement in the diet of people living in rural and remote Aboriginal communities in the NT and thereby improve the community's health
Characteristics of the survey:
  • Costing - compares the cost of a hypothetical basket of foods sufficient to meet the energy and nutrient needs of a hypothetical family of six people for fourteen days
  • Quality and variety
    1. collects information on the variety of foods available in the store
    2. scores the quality of fresh foods in the store

The Hypothetical Family:

  • an adult male aged 35 years
  • an adults female aged 30 years
  • a male teenager aged 14 years
  • a female child aged 8 years
  • a male child aged 4 years
  • an elderly woman aged 60 years

Family Nutrient Needs:

The Core Food Recommendations (Table 5) were used as a guide to selecting core foods commonly available in remote community stores which would meet the food requirements for the family of 6 for 14 days.

The nutrient needs for the family for 14 days were determined from the Australian Recommended Dietary Intakes for the age and gender of the "family" members, summed for all the members of the family and multiplied by 14.

The foods in the basket were analysed using Nuttab95 to ensure that the family RDI's were met. The Core Food amounts were adjusted to meet at least 100% of nutrient requirements (zinc being the limiting nutrient) and 75% of energy requirements. Margarine and sugar were added to supply another 20% of family energy needs. Thus, the basket of Core Foods plus fat and sugar provides 100% of nutrient requirements and 95% of energy requirements for the family. Less than 30% of total energy is derived from fat, 15% of energy is derived from protein and 54% energy from carbohydrate.

The Family Basket:

The family basket consists of the following foods:

Breads and Cereals

.

Flour

-

4 x 1 kgs packets

Bread

-

14 loaves

Weetbix

-

1 kg packet

Rolled Oats

-

1 kg packet

Long Grain Rice

-

1 kg packet

Canned Spaghetti

-

7 x 425g cans

.

Fruit

.

Apples

-

50 apples

Oranges

-

55 oranges

Bananas

-

55 bananas

Orange Juice

-

7 litres

Canned Fruit

-

7 x 440g cans

.

Vegetables

.

Potatoes

-

8 kilograms

Onions

-

3 kilograms

Carrots

-

4 kilograms

Cabbage

-

3 kilograms (1 large)

Pumpkin

-

3 kilograms

Fresh Tomatoes

-

2 kilograms

Canned Tomatoes

-

6 x 420g tomatoes

Canned Peas

-

6 x 420g peas

Canned Beans

-

7 x 440g beans

Baked Beans

-

7 x 425g baked beans

.

Meat & Alternatives

.

Corned Beef

-

7 x 340g cans

Meat and Vegetables

-

7 x 450g cans

Fresh/Frozen meat

-

1.5 kgs

Fresh/Frozen Chicken

-

1 kg

Eggs, 55's

-

1 dozen

.

Dairy

.

Powdered Milk

-

7 x 1 kgs tins

Cheese

-

3 x 250g packet

.

Other Foods

.

Margarine

-

4 x 500g packets

Sugar

-

4 x 1kg packets

Sugar

-

1 x 500g packet

Cost Comparisons:

  1. Comparisons between survey sites
    The cost of the family basket in a remote community store is compared with the cost in the nearest regional centre supermarket and a cost ratio determined.
  2. Comparisons with Social Security entitlements
    The cost of the family basket in a remote community store is compared with the Social Security entitlements of the family of six and a proportion of the family income necessary to purchase a basket of healthy foods is determined.

Criticisms

One frequently expressed criticism is the very small amount of meat in the basket.  As can be seen from the list above, the meat costed for a family of 6 people for 14 days is 7 tins of hamper Corned Beef, 7 x 450g tins of meat and vegetables, 1.5 kgs of fresh/frozen meat, 1 kg fresh/frozen chicken, and one dozen eggs.  Most people who have observed the eating preferences of Aboriginal people say that, in general,  meat is a much larger part of the diet than represented by the basket above.  

In answer to this criticism the following 2 points can be made:

  • the basket determines the cost 100% of the Core Food recommendations for meat, costs 190% of the RDI for protein, 137% of the iron and 100% of the zinc requirements for the family.  As such, the basket determines the cost of the bare minimum amount of healthy foods required to sustain the family in health indefinitely. 
Thus it can be concluded that this criticism is not justified.
Method:

Surveys are conducted over a 6 to 8 week period in April and May. The survey instrument is accompanied by a set of detailed instructions which help to ensure that the surveys are conducted in the same manner at each site. The surveyor gathers information on the brand, package size and cost for each survey item. The variety and quality sections of the survey also come with detailed instructions.

Information about brand name, size and cost of food items in the family basket are entered into an MicrosoftTM Excel® spreadsheet designed and written by Roy Price. The spreadsheet has been constructed to automatically determine a cost per kilogram for each food item, multiply the cost by the weight of the food item in the basket, and determine a cost of the family basket in each survey site.

Two colour reports with tables and graphs are automatically generated: one for the community members and another for the store manager.

Results:

In 1998 NT nutritionists conducted surveys in one supermarket in each capital city of Australia, each district centre of the NT, and in 35 Top End community stores and 12 Central Australian community stores. The results of the 1998 survey are in the public domain.

The 1998 survey reveals that, compared with the average capital city supermarket, a basket of food sufficient to provide 100% of the nutrient needs and 95% of the energy needs for a family of six people for 14 days is on average 17% more expensive in an NT district centre supermarket and on average 55% more expensive in an NT remote Aboriginal community store.

These results are summarised in a report available from the Food and Nutrition Unit, Health House, Darwin. A brief summary has been published in the December 1998 issue of the Territory Health Services Food and Nutrition Update.

The Future:

The information obtained from the surveys is used as a guide for activities to help improve the quality, availability and affordability of healthy foods in rural and remote community stores in the NT. It is intended that surveys will be conducted and reported annually.

The survey currently meets the needs of the NT nutritionists. However, there is plenty of room for improvement, especially in the area of the automatic reports and they require critical comment and review to ensure they have the impact they were designed to have.

Acknowledgments:

Development of the NT Nutritionist's Market Basket Survey would not have been possible without assistance from the following groups:

  • Kimberley Nutritionists who have been conducting the Kimberley Market Basket Survey for many years
  • NT Nutritionists who guided the development of the NT Market Basket Survey
  • North Queensland Tropical Public Health Nutritionists who provided valuable and constructive input into the development of the NT Market Basket Survey.

For further information about any aspect of the survey contact Roy Price.

 

References

  1. Online at http://www.unhchr.ch/html/menu6/2/fs2.htm
  2. Online at http://www.nhmrc.gov.au/publications/pdf/n31.pdf
  3. Marks, G. 2002. Monitoring that National Food Supply – availability, prices and quality. University of Queensland Nutrition Program.
  4. Leonard, D. 2003. "FoodNorth". Foodchain: Ensuring a safe and healthy food supply. SIGNAL Newsletter Issue 13, pp 17-18.
  5. Market Basket Survey of Remote Community Stores in the Northern Territory: April-June 2003. Nutrition and Physical Activity Program, NT Department of Health and Community Services.
  6. Gough, S. 1995. The Cost of Diet Related Disease in the NT. Background Paper prepared for the NT Food Project. Volume III: Nutrition and The Health System. NTDHCS.

 Copyright © 2004 All Rights Reserved.
Created by Roy Price, EthiCal Nutrition Services, POBox 1326, Alice Springs, Australia