Exploring the impacts of a fresh produce market program: a realist economic evaluation.

OBJECTIVE: To determine the contexts under which a fresh food market program is cost-effective in improving dignified access to nutritious food for food-insecure individuals. METHODS: A realist economic evaluation was employed. Purported cost related theories about how the program may function, known as context-mechanism-outcome configurations were developed. In-depth interviews with key stakeholders (program developers, funder, local food relief agencies, volunteers) involved in the program (n=19) as well Photovoice with focus groups with market attendees (n=8) were conducted and coded for contexts, mechanisms and outcomes. A cost-effectiveness analysis of the program was calculated whereby the cost inputs associated with operating the program were compared to the quantity and value of produce distributed. Alternative cost scenarios were evaluated in a sensitivity analysis. The cost-effectiveness analysis was used together with qualitative data to refine theory. RESULTS: Food insecure individuals attending a partnership fresh food market with a small fee, experienced improved, yet infrequent access to nutritious food through community connections and support a more dignified, viable access to fresh nutritious food. CONCLUSIONS: Food relief should consider alternative models. IMPLICATIONS FOR PUBLIC HEALTH: More dignified food relief programs that support local connections may be part of the solution to addressing food insecurity.

The impact of social enterprise on food insecurity - An Australian case study.

Like many high-income countries, in Australia there are a range of programmes in place, from social security to food banks, to help address food insecurity. So far, they have been unable to adequately alleviate and prevent this growing nutrition challenge. This paper presents an evaluation of a new type of intervention in the food security landscape, the social enterprise. The Community Grocer is a social enterprise that operates weekly fresh fruit and vegetable markets in Melbourne, Australia. The aim of the study was to examine the market's ability to increase access, use and availability of nutritious food in a socially acceptable way, for low socioeconomic status urban-dwelling individuals. The mixed-method evaluation included: comparative price audits (n = 27) at local (<1 km) stores; analysis of operational data from sample markets (n = 3); customer surveys (n = 91) and customer interviews (n = 12), collected in two phases (Autumn 2017, Summer 2018). The results found common (n = 10) fruit and vegetables cost, on average, approximately 40% less at the social enterprise, than local stores. Over twenty per cent of customers were food insecure and 80% of households were low income. Thirty-four different nationalities shopped at the market, and just over half (54%) shopped there weekly. More than 50 types of vegetables and fruit were available to purchase, varying for cultural preferences and seasonality, which supported variety and choice. Overall, this enterprise promotes food security in a localised area through low-cost, convenient, dignified and nutritious offerings.

Using unfolding case studies to better prepare the public health nutrition workforce to address the social determinants of health.

OBJECTIVE: The public health nutrition workforce has been reported to be underprepared for practice. The present study aimed to test the ability of an unfolding case study approach to support the public health nutrition workforce for the workplace, with a focus on improved access to nutritious food. DESIGN: Two unfolding case studies were trialled with undergraduate students in two-hour workshops to enhance their capability to address access to nutritious food as a social determinant of health. The approach provided information about the case using a staged approach that supported learners to review and reply to information and then continue this process as the case became increasingly complex. SETTING: Melbourne, Australia.ParticipantsThirty-eight undergraduate nutrition and dietetics students. RESULTS: The analysis revealed that the unfolding case study approach provided a place to challenge and deepen knowledge and think about the application of theory. As the cases developed and became more challenging, students were supported to consider appropriate approaches and recognised the constant evolution and dynamic nature of practice. CONCLUSIONS: This learning activity challenged students and supported deep learning about possible solutions. It may also be useful at a graduate level and for continuous education of nutritionists and/or dietitians to empower the workforce to address the social determinants of health, rather than just acknowledging them as a set of barriers that prevent people and communities from achieving optimal health. Further work is required to investigate how unfolding case studies in curricula shape preparedness for practice of public health nutrition.

A longitudinal study of the cost of food in Victoria influenced by geography and nutritional quality.

OBJECTIVE: To monitor the cost and affordability of a nutritious diet and to assess the influence of distance from the capital city and socioeconomic status on the cost of nutritious food in Victoria. METHODS: Twenty-six of Victoria's 79 local government areas (33%) were randomly chosen for inclusion in the study. A random sample of stores was selected for inclusion from each local government area. The cost of the 44 'healthy' and 10 'discretionary' food and drinks in the healthy food basket for a family of four for a fortnight was collected during the winter and summer of 2012, 2013 and 2014. RESULTS: The mean cost of the basket increased from $424.06 ± 38.22 in winter 2012 to $451.19 ± 33.83 in summer 2014 (p<0.001), representing about 31% of government benefit household income. Fruit and vegetables prices were the most varied over time. Distance of the store from state capital city centre predicted difference in food cost. CONCLUSIONS: These findings show that a healthy diet may be unaffordable for some Victorians. IMPLICATIONS: The cost of food is a key factor influencing intake. Public health strategies may need to consider strategies to make healthy food more affordable for some.