COST-EFFECTIVENESS OF FOOD IN PATIENTS USERS OF BRAZILIAN PUBLIC

HEALTH SYSTEM: DO YOU NEED SPEND MORE TO EAT BETTER?

VITOR BINI TEODORO 1

FERNANDA CRISTINA PEREIRA2
CÁSSIA AMÉLIA GOMES³

ABSTRACT: Despite being one of the largest food producers in the world, Brazil still faces
high levels of poor income distribution, directly influencing the diet of its population. The
present study sought to identify the food cost of users of the Brazilian Public Health System, in
the city of Bauru, State of São Paulo. through the use of a Food Frequency Questionnaire, to
measure the cost versus the quality of the food consumed and also the possibility of spending
less to eat better, using the Revised Healthy Eating Index (IQD-r). It was observed that a
significant portion of the sample spends more to consume products with lower quality,
concluding that it is possible to spend less and eat better, from the perspective of the diet
recommended in the Food Guide for the Brazilian Population.

Keywords: food security; nutritional education; food quality; food cost-effectiveness.

CUSTO-EFETIVIDADE DA ALIMENTAÇÃO EM PACIENTES USUÁRIOS DO

SUS: PARA ALIMENTAR-SE BEM, É PRECISO GASTAR MAIS?

Resumo: Apesar de configurar-se entre os maiores produtores de alimentos do mundo, o Brasil

enfrenta ainda níveis elevados de má distriuição de renda, influindo diretamente na alimentação
de sua população. O presente estudo buscou identificar o custo alimentar de usúarios do Sistema
Público de Saúde (SUS), no município de Bauru, Estado de São Paulo. através do uso de
Recordatório 24 horas, para mensurar o custo versus a qualidade dos alimentos consumidos e
ainda a possibilidade de se gastar menos para se alimentar melhor, utilizando o Indice
Qualidade da Dieta Revisado (IQD-r). Observou-se que parcela significativa da amostra gasta
mais para consumir produtos com menor qualidade, concluindo-se que é possível gastar menos
e comer melhor, sob a perspectiva da dieta preconizada no Guia Alimentar para a População
Brasileira.

Palavras-chave: segurança alimentar; educação nutricional; qualidade alimentar; custo-

efetividade alimentar

1
Doctoral Student in Agribusiness and Development– FCE-UNESP de Tupã. Email: vitor.bini@unesp.br.
2
Mastering Student in Agribusiness and Development – FCE-UNESP de Tupã. Email:
fernanda.c.pereira@unesp.br
³ Master in developmental and learning psychology – UNESP de Bauru. Email: cassia.csg38@gmail.com.
 1. INTRODUCTION
Brazil is one of the largest food producers in the world, with great expertise in large-scale
production of a wide range of agricultural commodities. On the other hand, the country is considered
one of the most unequal in the world in terms of income distribution among the population.
According to the Food and Agriculture Organization of the United Nations (FAO), this income
distribution. causes food insecurity, a phenomenon that occurs when an individual does not have
physical, economic and social access to food in order to satisfy their needs. daily (ONU, 2014).
The Brazilian case has an even more aggravating factor regarding the process of choosing
food: the poor distribution of income. Inequalities in income distribution favor the selection of lower-
cost foods, generally associated with large-scale and highly processed production. Thus, the income
of Brazilian families directly reflects on the cost of food, directly impacting their food quality. In this
way, the process of choosing food, as well as improvements in food education, become fundamental
public policies to ensure better nutrition. (MONTEIRO et al., 2000; WAXMAN, 2004; MONTEIRO,
2009; MONTEIRO et al., 2010).
In this sense, there is a need in all public health systems in the world to promote public policies
aimed at combating these diseases, combined with long-term strategies in order to provide better
quality of life for individuals, becoming a challenge in the face of new diet and food production
configurations (KINGDOM, 2003; CAMOSSA et al., 2005).
Brazil has a very significant peculiarity: the rural-city demographic transition that took place
in the country from the 1960s onwards and with greater celerity after the 1980s, also caused an intense
economic transition. While in the early 2000s, the rates of child malnutrition and individuals in
extreme poverty were alarming, the adoption of redistributive income transfer policies provided
access to subsistence food for a large number of overweight children and adults (MONTEIRO, 2009;
MARINHO et al., 2011). In other words, the economic transition process, despite providing access
to income, did not include a nutritional education policy. (TARDIDO and FALCÃO, 2006).
That said, the eating habits of a population with low schooling are transitioning to irregular
eating habits in the elderly. The concept of “eating well” is sometimes understood as synonymous
with “eating little”, or even less times a day (OMRAN, 2005; BRASIL, 2012; VASCONCELOS and
GOMES, 2012).
In this way, measuring the quality of food becomes crucial to better understand the behavior
of families at the table. In this sense, the quality of the diet can be measured through indices, such as
the Revised Healthy Eating Index (IQD-R) (FISBERG et al., 2004). At the same time, there is also a
Family Budget Survey (POF) carried out by the Brazilian Institute of Geography and Statistics
(IBGE), which aims to profile the living conditions of the Brazilian population based on consumption,
expenditure and income structures. of families. It was found that, in general, the Brazilian population
suffers from food shortages in some groups, such as vegetables and excess in others, such as white
flour and sugar. It also showed that a significant portion of the income of the Brazilian population is
spent on food (BORGES and CORDEIRO, 2015).

2. OBJECTIVES
 Analyze the consumption profile of patients using the Brazilian Public Health System, seeking
to establish the average cost of daily food contracting with the quality of the same, through the
Revised Healthy Eating Index (IQD-R).

3. METHODOLOGICAL PROCEDURES
It was sought to investigate the usual diet of patients treated by the Brazilian Public Health
System in the city of Bauru (SP), obtained through the application of Food Frequency Questionnaire,
seeking to observe the quantities and quality of food informed by patients. Subsequently, the foods
mentioned were converted into retail prices, obtained on average, in supermarkets in the
neighborhoods selected for the sample, within a radius of up to two kilometers from the reference
health center, totaling 21 establishments.
These values were converted into household measurements and cooking index to calculate the
price per edible fraction, as well as the cooking index to calculate the price of food prepared for final
consumption, providing an average value of the daily food of patients from all neighborhoods.
selected.
After obtaining these data and converting foods into nutrients, they were evaluated for diet
quality using the standardized calculation method for estimating the Revised Healthy Eating Index
(IQD-R).
This index defines the number of daily servings of food groups based on a 2,000kcal diet,
assigning a score to the consumption of each item. This makes it possible to assess the population's
adherence to nutritional recommendations through an error score of 100 points, with zero being the
worst and 100 the best diet, respectively.

4. RESULTS AND DISCUSSIONS

Foods with greater occurrence in the diets (rice, beans, meat, milk, bread roll), as well as foods
with lower incidence (fruits and vegetables) were observed. Based on this profile of the most
prevalent foods, we sought to establish a diet maximizing the food recommendations of the Food
Guide for the Brazilian Population (BRASIL, 2006), with five meals a day (three main meals and two
intermediate snacks).
Thus, six daily servings of carbohydrates, three servings of vegetables, three servings of fruits,
a serving of legumes, three servings of milk and dairy products, a serving of meat, a potion of oils
and fats and up to a portion of sugar.
Considering the prices collected in the city of Bauru, we also sought to list foods with lower
prices and greater acceptance for the composition of a diet with higher nutritional quality, as shown
in Table 01.

Table 01. Distribution of food, by food group, with higher prevalence

Food group Alimentos citados com maior prevalência de escolha
Carbohydrates Rice Corn Potato Pasta Bread roll
Vegetables Lettuce Zucchini Chayote Carrot
Frutas Banana Orange Apple
Milk and dairy products Whole Milk Fresh Cheese
 Leguminous Pinto beans
Meat Chicken
Oil and fats Butter Margarine
Sugars White sugar for coffee
Source: Research data.

The group with the highest score (score between 75.1 and 100 points) presented food at a
lower cost than the other groups, R$ 9.92 per day. On average, patients spent R$ 11.61 per day on
food. Listed the main foods consumed by the patients in the sample, from the prices obtained in the
field research and recommendations of the Food Guide for the Brazilian Population, a menu was
suggested containing six meals and contemplating food groups and varied foods within the
preferences of the individuals, as table 02. It is also possible to verify that the highest concentration
of patients is in the range between 50.1 and 75.0 points (328 patients), whose food has an average
cost of R$ 11.79, while the group below this (range of 25.1 and 50.0 points), presented a higher cost
in the daily diet as well as a lower quality of the diet.

Table 02. Cost of food consumed, according to score IQD-R

Patients Cost (R$)
IQD-R
N % µ DP
0,0-25,0 6 1,2% 9,97 7,25
25,1-50,0 78 15,8% 12,77 8,32
50,1-75,0 328 66,3% 11,79 7,66
75,1-100,0 83 16,8% 9,92 4,01
Total 495 100% 11,61 7,32
Source: Research data

From the estimate of the daily cost of food, the possibility of changing the diet at low cost was
verified, in order to reduce the impact of the income factor on decision-making for the improvement
of the nutritional quality of the population. The biggest barrier refers to the practicality and
palatability of certain processed foods, given their shelf life and ease of immediate consumption.
Considering the foods most frequently reported in the application of the Food Frequency
Questionnaire, it was possible to identify that small adjustments in the selection and acquisition of
food will be sufficient to improve the food quality of the sample, without compromising an additional
fraction of the family income with food. Contrariwise, in some cases, it would be possible to have a
lower expenditure for a healthier diet.

5. REFERENCES

BORGES, A. L.; CORDEIRO, Z. J. M. Sistemas de produção de baixo impacto para bananeira. In: Simpósio Brasileiro
Sobre Bananicultura. Belo Horizonte: EPAMIG, 2015.

BRASIL. Ministério da Saúde. Guia alimentar para a população brasileira. 2ª. ed. Brasília: Ministério da Saúde, 2014.
CAMOSSA, A. C. C.; COSTA, F. N. A.; OLIVEIRA, P. F. et al. Educação nutricional: Uma área em desenvolvimento.
Alimentos e Nutrição, v.16, n.4, p. 349-354, 2005.

FISBERG, R. M.; SLATER, B.; BARROS, R. R. et al. Índice de Qualidade da Dieta: avaliação da adaptação e
aplicabilidade. Rev. Nutr., v. 17, n. 3, p. 301-318, 2004.

KINGDON, J. Agendas, alternatives, and public policies. 3rd. Ed. New York: Harper Collins. 2003.

MARINHO, E.; LINHARES, F.; CAMPELO, G. Os programas de transferência de renda do governo impactam a pobreza
no Brasil?. Rev. Bras. Econ., v. 65, n. 3, p. 267-288, 2011.

MONTEIRO, C. A. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health
Nutr., v. 12, n. 5, p. 729-731, 2009.

MONTEIRO, C. A. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health
Nutr., v. 12, n. 5, p. 729-731, 2009.

MONTEIRO, C. A.; LEVY, R. B.; CLARO, R. M. et al. A new classification of foods based on the extent and purpose
of their processing. Cad. Saúde Pública, v. 26, p. 2039-2049. Rio de Janeiro, 2010.

MONTEIRO, C. A.; MONDINI, L.; COSTA, R. B. L. Mudanças na composição e adequação nutricional da dieta familiar
nas áreas metropolitanas do Brasil (1988-1996). Rev. Saúde Pública, v. 34, n. 3, p. 251-258, 2000.

OMRAN, A. R. The epidemiologic transition: A theory of the epidemiology of population change. The Milbank
Quarterly, , p.731-757. 2005.

ORGANIZAÇÃO DAS NAÇÕES UNIDAS PARA A ALIMENTAÇÃO E A AGRICULTURA (FAO). O estado da

Segurança Alimentar e Nutricional no Brasil: Um retrato multidimensional. Relatório 2014. Brasília, agosto 2014.

TARDIDO, A. P.; FALCÃO, M. C.; O impacto da modernização na transição nutricional e obesidade. Rev. Bras Nutr.
Clín. Vol. 21. Núm.2. p.117-124. São Paulo, 2006.

VASCONCELOS, A. M. N.; GOMES, M. M. F. Transição demográfica: a experiência brasileira. Epidemiol. Serv.

Saúde, v. 21, n. 4, p. 539-548, 2012.

WAXMAN, A. WHO Global Strategy on Diet, Physical Activity and Health. Food Nutr Bull, v. 25, n. 3, p. 292-302,
2004.