Significant inequalities in the cost of food for households with children in Israel in 2018

BACKGROUND: Dietary guidelines for families with children are designed to reach the Dietary Recommended Intake. However, the cost of a healthy diet and the extent to which families can afford it in Israel is unclear. METHODS: The distribution of ages and the number of children per household in Israel in 2018 was obtained from the Central Bureau of Statistics. Food prices were purchased from the commercial company Stornext. The cost of the recommended food items in the healthy diet for adults and children was calculated using standard food portions and meal frequency as well as a percentage of the household's net income. The proportion of households for which food expenditures exceed 15% of the net income was calculated by income quintiles, followed by changes in food prices during 2018. RESULTS: The average daily cost of a healthy diet was 35.51±7.7 new Israeli shekels (NIS). The older the individual, the more food costs increase. The ratio between the average cost of breakfast, lunch, dinner, and two intermediate meals was 1.5:3.4:1.2:1, respectively. The median monthly dietary cost for households with children as a percentage of net income was 20%. There was an inverse association with socioeconomic status (SES) as the median monthly food expenses for the first (lowest) quintile was 55% of the household's income and only 9.3% of the 5th (highest) income quintile. The food group that composed the highest component of the food budget was the vegetable group, with an average cost of 29% monthly, followed by the meat and meat substitutes group (19%). DISCUSSIONS: Policymakers should consider steps to decrease health inequality in food affordability targeting the three middle-lower income quintiles. The cost of a healthy diet compared with food expenditure in high-income countries was 1.8 higher in Israel. Our findings indicate that expanding the program to provide school lunches five days a week to more students would reduce household food expenditures by 15%. KEY MESSAGES: • Households with children in Israel would need to spend 20% of their net income to meet dietary guidelines. • Significant gaps by income quintile, number of children, and food group were identified.