Scholarly article on topic 'Assessing the variety and pricing of selected foods in socioeconomically disparate districts of Berlin, Germany'

Assessing the variety and pricing of selected foods in socioeconomically disparate districts of Berlin, Germany Academic research paper on "Agriculture, forestry, and fisheries"

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Academic research paper on topic "Assessing the variety and pricing of selected foods in socioeconomically disparate districts of Berlin, Germany"

J Public Health (2011) 19:23-28 DOI 10.1007/s10389-010-0357-3

ORIGINAL ARTICLE

Assessing the variety and pricing of selected foods in socioeconomically disparate districts of Berlin, Germany

Nanette Stroebele • Pia Dietze • Peter Tinnemann • Stefan N. Willich

Received: 17 February 2010/Accepted: 26 July 2010/Published online: 10 August 2010 © Springer-Verlag 2010

Abstract

Aim The neighbourhood environment appears to influence people's food consumption. Access, variety and pricing of foods play a role in the socioeconomic difference of fruit and vegetable consumption. This study compared differences in the number of grocery stores, variety of fresh fruits and vegetables, and food prices in districts with different Social Indices (SI) in Berlin, Germany. Methods The district with the lowest SIs was compared to the district with the highest SI. The number of grocery stores offering fresh produce, the variety of fresh fruits and vegetables, and prices of selected healthy and less healthy food items were assessed and compared. Results The low SI district had more grocery stores per residents than the high SI district. Variety and prices of fruits and vegetables did not differ between the two districts, but milk and whole wheat bread were less expensive in the high SI district. For all grocery stores, selected foods with higher energy density had lower energy costs than low energy density foods. Conclusion Health inequalities in Germany might be less influenced by access to healthy foods than in other countries, but nutrient-rich foods such as fruits and vegetables have higher energy costs than high energy dense foods.

Keywords Environment. Fruit and vegetables. Pricing. Accessibility. Variety

N. Stroebele (*) • P. Dietze • P. Tinnemann • S. N. Willich

Institute for Social Medicine, Epidemiology and Health Economy,

Charité University Medical Centre,

Luisenstr. 57,

10117 Berlin, Germany

e-mail: Nanette.Stroebele@charite.de

Introduction

Unhealthy dietary behaviour, in particular not consuming fruits and vegetables, has been shown to be particularly high among socioeconomically disadvantaged populations (Giskes et al. 2002; Hulshof et al. 2003). A systematic review revealed that household income appears to be consistently positively related to fruit and vegetable intake (Kamphuis et al. 2006), and lower socioeconomic groups seem to be less likely to follow existing dietary guidelines (Turrell et al. 2002).

Another factor that has been gaining attention recently is the possible influence of the neighbourhood food environment. Recent studies from the US suggest that residents of socioeconomically disadvantaged neighbourhoods have less access to affordable healthy food choices compared to those in high socioeconomic level neighbourhoods (Jetter and Cassady 2006; Hendrickson et al. 2006; Chung and Myers 1999; Moore and ez Roux 2006; Powell et al. 2007; Zenk et al. 2009). Healthier food choices in deprived areas differ in their availability, variety and price compared to healthier choices in less deprived areas. In deprived areas, fewer varieties of fresh fruits and vegetables are offered, and fresh produce tends to be more expensive (Hosler et al. 2008; Zenk et al. 2005). However, other studies show few or no differences in food prices, availability or access between deprived and affluent areas (Cassady et al. 2007; Smith et al. 2010; Winkler et al. 2006a; Winkler et al. 2006b). Two recent systematic reviews examining the empirical evidence found only little evidence for the influence of environmental factors on fruit and vegetable consumption (Giskes et al. 2007; Kamphuis et al. 2007).

Another aspect of the food environment has been gaining attention in the public health sector; high energy-

dense foods, high fat foods and general convenience, processed foods, including fast food, tend to be cheaper than healthy foods such as fresh fruits or vegetables (Drewnowski and Specter 2004; Darmon et al. 2004). Research on dietary behaviour and social inequalities suggests that low income households tend to purchase energy-dense foods that are nutrient poorer, but are affordably priced compared to more expensive nutrient-rich foods such as fresh fruits and vegetables (Drewnowski and Darmon 2005; Drewnowski 2009). Data from the US show an inverse relationship between the energy density of foods and the energy costs measured in USD/1,000kcal (Drewnowski and Darmon 2005). It is possible that lower food costs might be associated with higher energy-dense diets, which might lead to an increase in total energy intake. As a consequence, the higher prevalence of overweight and obesity in socioeconomically disadvantaged groups could be explained by this imbalance in the economics of food choice. Research in the area of the food environment and social inequality in Germany is lacking.

Although socioeconomic inequalities are less pronounced in Germany compared to other countries (van Doorslaer and Koolman 2004; Hernandez-Quevedo et al. 2006), prior research has shown that people of low economic standing in Germany have above average rates of malnutrition, eating disorders and obesity (Mackenbach et al. 2008; Robert Koch-Institut 2006). The capital city of Germany, Berlin, consists of a number of districts where inhabitants live under conditions differing widely by their socioeconomic situation, such as income, unemployment rate and ethnic background, as well as in their health and disease status (Senatsverwaltung fur Gesundheit, Umwelt und Verbraucherschutz 2009).

In this pilot study, we sought to determine if differences in the neighbourhood environment concernng food are apparent in Berlin, Germany. We analysed the two districts with the largest socioeconomic disparity and studied their store availability, produce prices, and fruit and vegetable variety.

Methods

This study investigated access to food within two districts in Berlin comparing the districts with the lowest and highest socioeconomic levels. The study examined (1) the number of grocery stores offering fresh produce, (2) the variety of fresh fruits and vegetables available to the consumers, and (3) the prices of a series of food items defined as healthy and unhealthy. Healthy food items included a series of popular fresh fruits and vegetables, milk and whole wheat bread. As unhealthy items, energy-dense food items, such as frozen pizza, chocolate and potato chips, were chosen.

Setting

Two areas in Berlin, similar in size but with a widely different socioeconomic population, were selected. The socioeconomic difference between the two areas was determined by a complex measuring tool called the Social Index (SI) created by the city of Berlin (Senatsverwaltung für Gesundheit, Umwelt und Verbraucherschutz 2009). The SI was developed to determine social differences between Berlin's neighbourhoods and to create a common ground for analysis and planning of social communities. Among other things, the index is based on unemployment rates, average per capita income, number of people on social welfare and life span expectancy. We chose to study the area of Kreuzberg, which lies within the community district of Kreuzberg-Friedrichshain and represents the neighbourhood with one of the lowest SIs in Berlin based on the SI of 2008. The other area chosen was Steglitz and Lankwitz, which is an area within the community district of Steglitz-Zehlendorf. Steglitz-Zehlendorf represents the neighbourhood that had the highest SI in Berlin in 2008. The net household income in Kreuzberg-Friedrichshain in 2006 was €1,175 per month, whereas the net household income in Steglitz-Zehlendorf was €1,850. The areas are roughly of the same size (10.4 km2 for Kreuzberg and 13.8 km2 for Steglitz and Lankwitz), but the population density is higher in Kreuzberg (14,239 residents/km2) compared to Steglitz and Lankwitz (8,085 residents/km2; Steglitz has 10,391 residents/km2, and Lankwitz has 5,778 residents/km2).

Availability

Within the districts, the number of food stores including organic grocery stores and farmers' markets was counted. Food stores were identified through systematic investigation of each and every street within the established district borders. Farmers' markets were located through Internet research. Food stores were defined as stores that offer at least one type of fresh vegetable and one type of fresh fruit (except lemons and limes). Food stores had to be open at least 5 days/week for 8 h/day. Farmers' markets were included if they were open for at least 6 h/week. Availability was defined as the number of food stores and farmers' markets per 10,000 residents.

Variety of fresh fruits and vegetables within food stores

The variety of food items was determined by a visual count of the different kinds of fresh fruits and vegetables available at each store by a trained surveyor of all non-organic food stores from May through July 2009. Given that organic food stores are still relatively rare as well as usually limited

in their fruit and vegetable variety, only non-organic food stores and foods were assessed. The following fresh fruit and vegetable items were summarised into larger categories and counted as one: berries (strawberries, cranberries, raspberries, blackberries), lemons (lemons and limes), melons (watermelons, cantaloupes, honeydews) and cabbage (red cabbage, green cabbage, Chinese cabbage). To control for seasonal variation and to increase comparability, we collected data concurrently in both districts and completed data collection within 12 weeks.

Pricing

For the purpose of price comparison between stores and districts, the most economical price for a sample of 12 products was recorded. The 12 products were chosen because of their popularity among the German population (DFHV 2009). Food prices of the following 12 food products were measured: apples, bananas, tomatoes, carrots, potatoes, whole wheat bread, fresh milk, frozen pizza, chocolate, potato chips and beer. Since the most economical price for each food was often found in bulk quantities, we calculated prices for predetermined amounts. Prices for fresh fruit and vegetable items were noted per 1 kg (1,000 g). Prices for whole wheat bread, chocolate and chips were recorded per 100 g. Fresh milk prices were recorded as price per carton (1 l), beer prices as the cost per 0.5 l and frozen pizza as the price for one pizza (300 g). Organic food stores were not entered into the recording of prices or produce variety because their high quality standards often cause costs to increase, which makes the items sold unaffordable for many people, and high prices would result in distorted price averages.

Statistical analysis

Analysis of variance was used to examine differences by district (low SI vs. high SI) in the mean number of fruits and vegetables and the mean lowest prices of the selected food items available in all stores. Using the average caloric content of selected food items (100 g pizza = ca. 216 kcal, 100 g potato chips = ca. 547 kcal, 100 g chocolate = ca. 536 kcal, 100 g apples = ca. 49 kcal, 100 g bananas = ca. 95 kcal and 100 g carrots = ca. 25 kcal), the relationship between energy costs (euro/1,000 kcal) and energy density (kcal/g) of each food item was calculated.

Results

The low SI district (Kreuzberg) had greater access to supermarkets compared to the district with a high SI (Steglitz + Lankwitz). Per 10,000 residents, in the low SI district, 5.88 food stores (including farmers' markets and organic food stores; N = 87) were available compared to only 4.42 food stores in the high SI district (N = 46). More organic food stores and farmers' markets were available in the low SI area compared to the high SI area.

The number of types of fruits and vegetables in the low SI district did not differ significantly from the number of types of fruits and vegetables in the high SI district (Table 1).

In the low SI district, prices of the selected food items were assessed in 72 grocery stores, including 13 supermarkets, 23 discounters and 36 farmers' markets. In the high SI district only 45 grocery stores, including 18 supermarkets, 18 discounters and 9 farmers' markets, were found. Including all types of food stores (supermarkets, discounters and

Table 1 Fruit and vegetable variety and mean pricing in Euros (€) and standard error of the mean (SEM) of foods by neighbourhood socioeconomic standing

*p < 0.05 fp < 0.01

Low SES (N = 72) High SES (N = 45)

Number of fruits (SD) 14.21 (5.94) 16.09 (3.23)

Number of vegetables (SD) 18.75 (6.13) 20.64 (4.14)

Apples (1,000 g) in € (SEM) 1.44 (0.06) 1.49 (0.08)

Bananas (1,000 g) in € (SEM) 1.39 (0.05) 1.42 (0.07)

Tomatoes (1,000 g) in € (SEM) 1.93 (0.09) 1.59 (0.11)

Carrots (1,000 g) in € (SEM) 1.30 (0.04) 1.12 (0.06)

Potatoes (1,000 g) in € (SEM) 0.85 (0.05) 0.84 (0.04) f

Whole wheat bread (100 g) in € (SEM) 0.19 (0.03) 0.14 (0.00) f

Fresh milk (1 l) in € (SEM) 0.63 (0.04) 0.48 (0.00) f

Frozen pizza (300 g) in € (SEM) 0.83 (0.06) 0.71 (0.01)*

Chocolate (100 g) in € (SEM) 0.51 (0.04) 0.36 (0.00) f

Potato chips (100 g) in € (SEM) 0.46 (0.04) 0.30 (0.02) f

Beer (0.5 l) in € (SEM) 0.41 (0.03) 0.34 (0.03)

Cigarettes (17 per packet) in € (SEM) 3.39 (0.03) 3.28 (0.01) f

♦4 ♦ Chocolate Pizza A Potato Chips Apple Banana O Carrot

0 1 2 3 4 5 6

Energy Cost (€/1000kcal)

Fig. 1 Relationship between energy density (kcal/g) and energy costs (euro/1,000 kcal) of selected food items

farmers' markets), fruits and vegetables did not differ in pricing between the two districts. No differences were found for apples, bananas, tomatoes, carrots and beer. Potatoes (F = 9,122, p = 0.003), whole-wheat bread (F = 9,527, p = 0.003), fresh milk (F = 56,179, p = 0.000), chocolate (F = 40,489, p = 0.000), potato chips (F = 32,655, p = 0.000) and frozen pizza (F = 5,819, p = 0.018) were significantly cheaper in the high SI district compared to the low SI district (Table 1). However, when the local farmers' markets, which were more common in the low SI district, were taken out of the analysis, the only four remaining items that were less expensive in the high SI district were whole wheat bread (0.16 vs. 0.14; F = 20,208, p = 0.000), fresh milk (0.50 vs. 0.48; F = 6,634, p = 0.012) and potato chips (0.29 vs. 0.28; F = 6,081, p = 0.016). Without the farmers' markets, bananas were cheaper in the low SI district compared to the high SI district (1.18 vs. 1.13; F = 10,589, p = 0.002).

To compare pricing of selected low and high energy-dense foods, the mean prices of all grocery stores for the following food items were chosen: chocolate, potato chips, pizza, apples, bananas and carrots. Figure 1 shows the relationship between energy density (kcal/g) and energy costs (euro/1,000 kcal) of a selection of low and high energy-dense foods. It shows that energy costs for apples (3.26€/1,000 kcal), bananas (4.10€/ 1,000 kcal) and carrots (4.88€/1,000 kcal) are higher than for pizza (2.16€/1,000 kcal), potato chips (0.84€/1,000 kcal) and chocolate (0.66€/1,000 kcal), whereas energy density is higher for pizza (2.16 kcal/g), potato chips (5.47 kcal/g) and chocolate (5.36 kcal/g) compared to apples (0.49 kcal/g), bananas (0.95 kcal/g) and carrots (0.25 kcal/g).

SI area compared to the high SI area. The variety of fruits and vegetables did not differ between the districts, and no differences could be found in terms of fruit and vegetable prices. These findings are in line with several other studies (Smith et al. 2010; Zenk et al. 2009; Cassady et al. 2007) . However, other food items such as fresh milk and whole wheat bread tended to be cheaper in the high SI district, which in part supports the idea that healthy food choices tend to be more expensive in more disadvantaged neighbourhoods.

Looking at high-fat/energy-dense foods such as pizza, potato chips and chocolate, significantly higher prices were observed in the low SI neighbourhood. A possible explanation for the higher prices could be that grocery stores simply sell some products at a higher price in neighbourhoods with a higher demand for these types of foods and products. Since this effect is mainly observed for unhealthy food items and not for fruits and vegetables, it raises the question of the possibility of an existing health inequity based on socioeconomic standing.

In general, food pricing in Germany appears to be similar to food pricing in other nations, with energy-dense foods being the lowest cost dietary options. For people with a low SI, the financial aspect of foods most likely plays a crucial role in their purchase behaviour.

Limitations of this study

Several limitations of this study need to be mentioned. This was a pragmatic case study approach with the focus on two geographically comparable areas in one particular city. Mainly the population density between the two districts differed. This approach does not allow the comparison of associations between neighbourhood deprivation and food accessibility for the full range of urban and rural settings across the world or even only across Germany.

The findings of this study can only be generalised to the study region, and spatial inequality might exist in rural and small town settings in Germany. In addition, no information on residents' shopping behaviours was obtained, and food quality was also not addressed. Other food outlets, such as convenience stores without fresh fruits and vegetables, restaurants and snack bars, which might play a role in determining food item pricing, were also not examined.

Possible implications and future research

Discussion

The variety and prices of the examined food items were similar in the high and low socioeconomic districts. More grocery stores per 10,000 residents were found in the low

To our knowledge, this is the first study in Germany looking at neighbourhood food environments. The findings showed that the food environment in a socioeconomically disadvantaged area was as conducive to buying healthier food choices as in a more advantaged area. One possible explanation could be that within the German population,

social inequality is less pronounced than in other countries such as the US, and therefore the difference in social status in the chosen urban districts was too small to be a factor in the food environment.

However, for the districts observed, energy-dense foods were cheaper and therefore potentially more in demand in low SI districts than nutrient-rich foods. Nevertheless, while prices for healthy foods appear to be similar in the districts, the purchase of such foods is determined by financial resources available to buyers. In particular, food inequity could be questioned since people with lower purchasing power have to pay similar prices for healthy foods compared to those with higher purchasing power.

Our findings could suggest that inequalities in food intake may have little to do with the food environment in Germany, but rather with the economics of food choice. Social inequality in Germany has been linked to obesity and other chronic disease, and, as Drewnowski and colleagues (Drewnowski and Darmon 2005; Drewnowski 2004) have recently pointed out, more likely factors for the lower nutritional quality of diets of low-income households could be the low cost of energy-dense foods. Thus, as long as energy-dense foods are highly palatable and cheaper, we believe it will be difficult to change low-income household's food choices, and health inequity through pricing remains.

Further research needs to be conducted not only in other geographical areas in Germany and Europe in general, but also in other mechanisms such as cooking skills and habits in households as well as food costs and their relationship with energy density. Currently not enough is known about if and how household food shopping environments affect a population's intake of fruits and vegetables and the relationship to socioeconomic inequalities in food intake.

Conflict of interest statement The authors declare that they have no conflict of interest.

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