An environmental scan of financial incentives to increase access to healthy foods: How, how much, and how often?

backgroundDiet quality significantly influences chronic disease prevalence. Interventions that promote healthier food purchases through economic incentives are gaining attention, but there is limited information on the practical aspects of implementing these programs as a health promotion strategy in retail grocery store settings. This study explores common incentive structures, their monetary values, and distribution frequencies.

methodsA structured environmental scan of academic and grey publications from January 2010 to August 2021 was conducted. Sources from Canada, the United States, the United Kingdom, New Zealand, and Australia were included if they described interventions initiated by organizations to reduce the cost of healthier foods in retail grocery stores without requiring a prescription or disease diagnosis. Data were extracted in duplicate and synthesized narratively, focusing on the type, value, and how often incentives were distributed. The median, rather than the mean, was calculated to account for skewed distributions of incentive values across programs. Monetary values were standardized to weekly amounts and adjusted to 2024 US dollars.

resultsFrom 4,953 academic and 40 grey literature sources, 17 programs were identified. These programs featured four incentive structures: price discounts (41%), food vouchers (24%), rewards (18%), and hybrid structures (18%). The median incentive value was $14.38 per week. Incentives were typically provided weekly (29%) or monthly (18%), with some offered per-shop, per-day, or once per program.

conclusionsConsiderable heterogeneity was observed in incentive structures, values, and frequencies. Justifications for these designs were often lacking, highlighting the need for further research that directly compares the impact of different incentive structures, amounts, and frequencies on food purchases. Until more empirical evidence is available, program design choices can be guided by precedent, modeled after policy options under consideration (e.g., exempting beneficiaries from general sales tax on fresh produce), or built upon successful existing models, such as the United States Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program.