What South Africa’s Successful Push To Incentivize Healthy Eating Could Teach The U.S.

On Tuesday, the RAND Corporation published the results of a preliminary study on South Africa’s HealthyFood initiative, a benefit program sponsored through the nation’s largest private insurance company. The program provides some 260,000 South African households with up to a 25 percent rebate on healthy food purchases — “cash for carrots,” if you will — and the encouraging numbers suggest that similar initiatives could work right here in America.

While the study does suffer from some methodological snags — the biggest being that households’ eating habits were self-reported rather than observed — its authors conclude that the right level of rebates can be a strong catalyst for healthier eating habits. For instance, the survey of 350,000 HealthyFood participants and nonparticipants found that “a 10% and 25% discount on healthy food purchases is associated with an increase in daily fruits and vegetables consumption by 0.38 (95% CI: 0.37–0.39) and 0.64 (95% CI: 0.62–0.65) servings, respectively,” and that rebate participants were more likely to eat three or more servings of wholegrain foods daily while being less likely to eat foods high in sugar, salt, fried foods, processed meats, and fast food.

Admittedly, the report does not find that the healthier eating habits significantly reduced overweight rates or participants’ average BMIs. However, it does see a statistically significant correlation between higher discount rates and lower obesity, suggesting that the right amount of financial motivation can spur enough eating habit changes to make a dent in obesity rates on the macro level.

So could a similar program work in the U.S. — particularly for low-income Americans who struggle with food insecurity, and often have to resort to high-fat and high-calorie diets to get more nutritional “bang-for-the-buck”? There’s not a whole lot of data on the matter yet. But that will soon change, as a 2011 pilot program under the Supplemental Nutrition Assistance Program (SNAP) — the “Healthy Incentives Pilot” — mimics the HealthyFood initiative, offering inflated discounts of up to 30 percent cash back on healthy food purchases, and its results will be published later this year. If the findings track South Africa’s, then it could be a game changer for low-income communities often beset by unhealthy food habits and high obesity rates. And incentivizing healthy eating with rebates could be a more effective policy than more blunt and restrictive initiatives, like South Carolina Gov. Nikki Haley’s (R) controversial push to limit food stamp purchases to healthy items.


Still, the funding element is key, as the study found that higher rebate levels were required to change the eating habits of people who were entrenched in subpar diets. The South African program offers monthly discounts of up to $500 for a family and $250 for individuals — significantly higher than the average monthly SNAP allotment, which is supposed to be a supplemental benefit (although it doesn’t actually work that way in reality). But South Africa’s example suggests that, given sufficient financial backing, cash for carrots could be a worthwhile undertaking throughout America.