nutrients Article Cost and Affordability of Healthy, Equitable and Sustainable Diets in Low Socioeconomic Groups in Australia Meron Lewis 1,2, * , Sarah A. McNaughton 3 , Lucie Rychetnik 2,4 and Amanda J. Lee 1   Citation: Lewis, M.; McNaughton, S.A.; Rychetnik, L.; Lee, A.J. Cost and Affordability of Healthy, Equitable and Sustainable Diets in Low Socioeconomic Groups in Australia. Nutrients 2021, 13, 2900. https:// doi.org/10.3390/nu13082900 Academic Editors: Clare Collins and George Moschonis Received: 21 July 2021 Accepted: 19 August 2021 Published: 23 August 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia; amanda.lee@uq.edu.au 2 The Australian Prevention Partnership Centre, The Sax Institute, Glebe, NSW 2037, Australia; lucie.rychetnik@saxinstitute.org.au 3 Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3217, Australia; sarah.mcnaughton@deakin.edu.au 4 School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia * Correspondence: meron.lewis@uq.net.au Abstract: Few Australians consume a healthy, equitable and more sustainable diet consistent with the Australian Dietary Guidelines (ADGs). Low socioeconomic groups (SEGs) suffer particularly poor diet-related health problems. However, granular information on dietary intakes and affordability of recommended diets was lacking for low SEGs. The Healthy Diets Australian Standardised Affordabil- ity and Pricing protocol was modified for low SEGs to align with relevant dietary intakes reported in the National Nutrition Survey 2011–2012(which included less healthy and more discretionary options than the broader population), household structures, food purchasing habits, and incomes. Cost and affordability of habitual and recommended diets of low SEGs were calculated using prices of ‘standard brands’ and ‘cheapest options’. With ‘standard brands’, recommended diets cost less than habitual diets, but were unaffordable for low SEGs. With ‘cheapest options’, both diets were more affordable, but recommended diets cost more than habitual diets for some low SEGs, potentially contributing to perceptions that healthy food is unaffordable. The study confirms the need for an equity lens to better target dietary guidelines for low SEGs. It also highlights urgent policy action is needed to help improve affordability of recommended diets. Keywords: diet cost; diet affordability; low socioeconomic; low income; healthy eating; dietary guidelines; Australia 1. Introduction There is an urgent need for food system transformation to produce healthy, equitable and more environmentally sustainable diets for all people [1,2]. Poor diet is a leading contributor to the burden of disease in Australia [3,4]. Fewer than 4% of Australians consume a healthy, equitable and more sustainable diet consistent with the Australian Dietary Guidelines (ADGs) [5,6]. More than one-third of adults’ and more than 40% of children’s energy intake comes from “discretionary” food and drinks. These discretionary food and drinks are not needed for health and are high in saturated fat, added sugar, salt and/or alcohol [6]. Low socioeconomic groups (SEGs) suffer poorer diet-related health problems than the broader population, including higher rates of chronic disease such as diabetes, heart disease, and some cancers [7–9]. 1.1. Key Considerations in Understanding Determinants of Inequitable Dietary Patterns A recent systematic review of habitual dietary intake of low SEGs in Australia found that while total diet quality is generally lower in low SEGs compared to higher SEGs, findings were inconsistent across studies for all reported food groups and SEG measures due to variation between study metrics, definitions, dietary assessment methods, and Nutrients 2021, 13, 2900. https://doi.org/10.3390/nu13082900 https://www.mdpi.com/journal/nutrients