Context
Eating healthily on a low budget is a challenge for many households: today in France, 14% of the population lives below the poverty line, i.e. 8.8 million people. Among them, only 5 million receive food aid (IGAS, 2019). The cost of food thus plays an important role in inequalities in nutrition and health. There is a linear relationship between income and the prevalence of obesity, suggesting a causal relationship.
Today, the structure of food prices does not promote healthy eating: while the price of calories is on average equal to € 0.70 per 100 kcal supplied by fruits and vegetables and € 0.60 per 100 kcal supplied by meat or fish, it is generally less than € 0.20 per 100 kcal from fat or fatty, salty, sweet products. Thus, budgetary constraints, when they are high, tend to orient towards choices that are less favorable to health.
In addition, the minimum cost of food allowing compliance with all French nutritional recommendations is €3.5 / day / person, which is higher than the average budget of food aid recipients, being around €2.5 / person / day. This shows that below a certain level of income, education is no longer enough to allow households to eat healthily: help is required. However, above €3.5 / day / person, it is possible to eat well by having optimal purchasing instructions.
Project
Opticourses is a health promotion program on diet and budget. This program was developed and validated as part of an action research project led by Nicole Darmon (research director at INRAE), Hind Gaigi and Christophe Dubois, launched in 2010 in Marseille thanks to funding from the Agency Regional Health PACA, then the National Cancer Institute.
Its objective is to help households in financial difficulty, in order to facilitate their access to healthy food.
The program is divided into two parts:
- Offer: for 6 months, foods of good nutritional quality / price ratio (QNP) (legumes, starchy foods, etc.) were made available, visible and attractive on the shelves of two supermarkets in disadvantaged areas in the north of Marseille, with the logo "Eat Top".
- Request: thematic workshops led by professionals trained in the Opticourses approach are offered. They are based around fun activities on purchasing practices, the nutritional quality of food, their price and taste, in order to discuss the concept of good QNP foods. In particular, a “Threshold Price” booklet is distributed to participants to help them identify foods of good QNP value when they are shopping. Cash receipts brought by the participants make it possible to make the discussions concrete, and to value the feedback of experiences between participants. In addition, each participant is invited to keep the receipts of his home for 1 month, and receives at the last session a personalized assessment with advice and shared identification of an acceptable change (the only activity that is not collective ).
Results
Supply side: As from three months into the experiment, an increase in sales of targeted products was observed in the stores where the "Eat Top" operation took place.
Demand side: the assessment of the impact of the workshops highlighted an evolution in consumption practices towards more healthy products, at constant cost. The effects of the project are not only measured on a declarative basis: an original method intended to limit the declaration biases while preserving the self-esteem of the participants was adapted to observe developments in a rigorous manner.
Health logos, nutrition information and even subsidies can increase inequalities in nutrition and health.
Faced with the ineffectiveness of health injunctions, the Opticourses project therefore makes it possible to demonstrate that long-term participatory approaches, carried out in direct contact with the beneficiary audiences and in a fun and appropriate manner, make it possible to obtain encouraging results. Eating healthy is therefore possible with a minimum of 3.5 € / day / person.
The Little Extra
The project is now in the transferability phase in the South region, but also in the rest of French territory. This will make it possible to test the replicability of the Opticourses protocols and tools in other contexts, to consider its wide dissemination if necessary. Training sessions are offered to train new workers.
En savoir plus sur la méthodologie utilisée.
Written by Eva Morel, LFC volunteer - March 2020.
Last modification : 08 Jun 2020.
INRA - Opticourses
Opticourses is an action research project led by Nicole Darmon (director of research at INRA), launched in 2010 in Marseille with funding from the Agence Régionale de Santé PACA, then from the National Cancer Institute. Its objective is to help households in financial difficulty, in order to facilitate their access to healthy food.