Are Low-Income Consumers Willing to Pay for Fortification of a Commercially Produced Yogurt in Bangladesh.

BACKGROUND: There is an active debate over the potential for market-based strategies to address micronutrient deficiencies in low- and middle-income countries. However, there are questions over the viability of market-based strategies, reflecting limited evidence on the value that low-income households attach to the nutritional attributes of processed foods. OBJECTIVE: The objective of this article is to investigate the willingness to pay of primary food purchasers in low-income households in rural Bangladesh for Shokti+, a nutritionally fortified yogurt produced and distributed by Grameen Danone Foods Limited. METHODS: A real choice experiment with economic incentives was conducted with 1000 rural food purchasers sampled from the distribution area of Shokti+ in rural Bangladesh. The choices of respondents revealed attribute nonattendance, favoring the fortification attribute over price. RESULTS: Results from a random parameter logit model found that respondents were willing to pay an average of 18 BDT (US$0.22) for fortification and 6 BDT (US$0.073) for brand name. The market price for Shokti+ at the time of the study was 10 BDT (US$0.12). The results from a random effects model suggest the magnitude of willingness to pay for fortification was primarily driven by the nutritional awareness of respondents but offset by household food insecurity. CONCLUSIONS: The article concludes that, while there is a viable market for fortified yogurt in rural Bangladesh, efforts to promote this product as a strategy to address micronutrient deficiency are best targeted at low-income households with some capacity to pay for low priced commercially produced foods.

Innovation in regulation of rapidly changing health markets.

The rapid evolution and spread of health markets across low and middle-income countries (LMICs) has contributed to a significant increase in the availability of health-related goods and services around the world. The support institutions needed to regulate these markets have lagged behind, with regulatory systems that are weak and under-resourced. This paper explores the key issues associated with regulation of health markets in LMICs, and the different goals of regulation, namely quality and safety of care, value for money, social agreement over fair access and financing, and accountability. Licensing, price controls, and other traditional approaches to the regulation of markets for health products and services have played an important role, but they have been of questionable effectiveness in ensuring safety and efficacy at the point of the user in LMICs. The paper proposes a health market systems conceptual framework, using the value chain for the production, distribution and retail of health goods and services, to examine regulation of health markets in the LMIC context. We conclude by exploring the changing context going forwards, laying out implications for future heath market regulation. We argue that the case for new approaches to the regulation of markets for health products and services in LMICs is compelling. Although traditional "command and control" approaches will have a place in the toolkit of regulators, a broader bundle of approaches is needed that is adapted to the national and market-level context of particular LMICs. The implication is that it is not possible to apply standard or single interventions across countries, as approaches proven to work well in one context will not necessarily work well elsewhere.

Assessment of consumers' level of engagement in following recommendations for lowering sodium intake.

Population-wide sodium reduction strategies encourage consumer participation in lowering dietary sodium. This study aims to measure and rank consumers' level of engagement in following 23 recommendations to reduce dietary sodium and to compare variation in level of consumers' engagement by sociodemographic sub-groups. The study included 869 randomly selected participants of an online food panel survey from Ontario during November and December 2010. Rasch modelling was used for the analysis. Consumers were less likely to be engaged in 9 out of the 23 recommendations, in particular those related to avoiding foods higher in sodium and implementing sodium reduction strategies while eating in restaurants. Higher level of consumers' engagement was observed in relation to food preparation practices, including use of low sodium ingredients. In comparison to the relevant reference group, men, older individuals, with lower educational level, single, and those who do not prepare food from scratch showed an overall lower level of engagement in following recommendations to lowering dietary sodium, particularly related to avoiding processed foods. These data provide novel insights and can inform public education campaigns, and highlight the need for interventions and programs targeted at the food supply that can assist consumers in lowering their sodium intake.

Difficulty of healthy eating: a Rasch model approach.

This study aims to measure the difficulty of healthy eating as a single latent construct and, within that, assess which dietary guidelines consumers find more or less difficult to comply with using the Rasch model approach. Participants self-reported their compliance with 12 health-promoting dietary recommendations related to cooking methods and consumption of specific food items. Data were drawn from a survey elicited using a longitudinal consumer panel established in the City of Guelph, Ontario, Canada in 2008. The panel consists of 1962 randomly-selected residents of Guelph between the age of 20 and 69 years. The response rate was equal to 68 percent. The main assumptions of the Rasch model were satisfied. However, subsequent differential item functioning analysis revealed significant scale variations by gender, education, age and household income, which reduced the validity of the Rasch scale. Conversely, these scale variations highlight the importance of socio-economic and demographic factors on the difficulty of healthy eating.

Understanding the propensity of consumers to comply with dietary guidelines directed at heart health.

The aim of this paper is to explore the difficulty faced by consumers in complying with health-related dietary guidelines, focusing on those guidelines that consumers find it more/less difficult to meet and the factors driving the ability to make associated dietary changes. Participants reported self-assessed compliance with 12 dietary recommendations predominantly directed at reducing the risk of heart disease. The difficulty of complying with each of the dietary guidelines was measured using a Rasch model, while the determinants of ability to comply with the dietary recommendations as a whole were identified using regression analysis. The more difficult dietary recommendations included limiting consumption of red meats and consuming the recommended daily intake of fruits and vegetables. Attitudinal variables associated with food, nutrition and health, perception of cholesterol risk and a range of socio-demographic variables, including age, gender and education, were significant determinants of person ability to comply with the dietary recommendations. The results show that there are significant differences in the difficulty faced by consumers in complying with particular dietary recommendations, while there is substantial variation in the ability to eat a healthy diet across participants.

Understanding the complexities of private standards in global agri-food chains as they impact developing countries.

The increasing prevalence of private standards governing food safety, food quality and environmental and social impacts of agri-food systems has raised concerns about the effects on developing countries, as well as the governance of agri-food value chains more broadly. It is argued that current debates have been 'clouded' by a failure to recognise the diversity of private standards in terms of their institutional form, who develops and adopts these standards and why. In particular, there is a need to appreciate the close inter-relationships between public regulations and private standards and the continuing ways in which private standards evolve.

Who consumes functional foods and nutraceuticals in Canada? Results of cluster analysis of the 2006 survey of Canadians' demand for food products supporting health and wellness.

This research seeks to identify consumer segments related to consumption of functional food and nutraceutical products in Canada. The segments are differentiated by consumer receptivity to functional foods and nutraceuticals. In turn, receptivity is tied to attitudes, motivations and knowledge related to food/diet and connections with health. At one extreme, a segment emerges that is highly receptive to functional foods and nutraceuticals, and shows a keen interest in learning about foods that have health benefits. A second segment, conversely, has low receptivity, but demonstrates a higher degree of knowledge related to the relationship between food/diet and health. A key driver of receptivity towards functional foods and nutraceuticals appears to be perceptions of disease threat, which tend to increase with age. Pre-emptive use of messages relating to the preventative properties of these products does not seem to have a major impact on the receptivity of consumers.

Population distribution and burden of acute gastrointestinal illness in British Columbia, Canada.

BACKGROUND: In developed countries, gastrointestinal illness (GI) is typically mild and self-limiting, however, it has considerable economic impact due to high morbidity. METHODS: The magnitude and distribution of acute GI in British Columbia (BC), Canada was evaluated via a cross-sectional telephone survey of 4,612 randomly selected residents, conducted from June 2002 to June 2003. Respondents were asked if they had experienced vomiting or diarrhoea in the 28 days prior to the interview. RESULTS: A response rate of 44.3% was achieved. A monthly prevalence of 9.2% (95% CI 8.4-10.0), an incidence rate of 1.3 (95% CI 1.1-1.4) episodes of acute GI per person-year, and an average probability that an individual developed illness in the year of 71.6% (95% CI 68.0-74.8), weighted by population size were observed. The average duration of illness was 3.7 days, translating into 19.2 million days annually of acute GI in BC. CONCLUSION: The results corroborate those from previous Canadian and international studies, highlighting the substantial burden of acute GI.

Public perceptions of drinking water: a postal survey of residents with private water supplies.

BACKGROUND: In Canada, the legal responsibility for the condition of private water supplies, including private wells and cisterns, rests with their owners. However, there are reports that Canadians test these water supplies intermittently and that treatment of such water is uncommon. An estimated 45% of all waterborne outbreaks in Canada involve non-municipal systems. An understanding of the perceptions and needs of Canadians served by private water supplies is essential, as it would enable public health professionals to better target public education and drinking water policy. The purpose of this study was to investigate the public perceptions of private water supplies in the City of Hamilton, Ontario (Canada), with the intent of informing public education and outreach strategies within the population. METHODS: A cross-sectional postal survey of 246 residences with private water supplies was conducted in May 2004. Questions pertained to the perceptions of water quality and alternative water sources, water testing behaviours and the self-identified need for further information. RESULTS: Private wells, cisterns or both, were the source of household water for 71%, 16% and 13% of respondents, respectively. Although respondents rated their water quality highly, 80% also had concerns with its safety. The most common concerns pertained to bacterial and chemical contamination of their water supply and its potential negative effect on health. Approximately 56% and 61% of respondents used in-home treatment devices and bottled water within their homes, respectively, mainly due to perceived improvements in the safety and aesthetic qualities compared to regular tap water. Testing of private water supplies was performed infrequently: 8% of respondents tested at a frequency that meets current provincial guidelines. Two-thirds of respondents wanted more information on various topics related to private water supplies. Flyers and newspapers were the two media reported most likely to be used. CONCLUSION: Although respondents rated their water quality highly, the majority had concerns regarding the water from their private supply, and the use of bottled water and water treatment devices was extensive. The results of this study suggest important lines of inquiry and provide support and input for public education programs, particularly those related to private water testing, in this population.