Concepts and methods used in research relevant to the costs of healthy living.

Much research related to the costs of healthy living has used traditional distributional measures of poverty such as the European standard ‘at risk of poverty’ indicator (household equivalised disposable income below 60 % of the national median). However, there are several other established methods for conceptualising and measuring the costs of healthy living. These methods have a stronger theoretical and empirical basis for hypothesised impacts on health outcomes and have been calculated based on real costs of healthy living.

Minimum Income for Healthy Living (MIHL)

The concept of a ‘Minimum Income for Healthy Living’ (MIHL) is both an economic and social concept used in epidemiological research.  The concept of a MIHL was originally conceived by pioneering epidemiologist Jerry Morris using survey and expenditure data alongside expert judgement to estimate an MIHL threshold, and applying this concept first to young, single men and then to older adults.  The idea of a minimum income has a much longer history and can be traced back to philosophers and thinkers like Thomas More and Thomas Paine. However, the specific concept of MIHL emphasises not just survival but a standard of living that can support good health and well-being.

MIHL refers to the amount of income an individual or family requires to maintain a standard of living that promotes good health and well-being: “Half a century of research has provided consensual evidence of major requisites of adult health, and lower disease and death rates, particularly in nutrition, physical activity and psychosocial relations.” This goes beyond basic necessities and can include:

  • Nutrition: Enough income to purchase a balanced diet that meets all nutritional needs.
  • Housing: A safe and stable living environment free from hazards and with adequate sanitation facilities and facilities for the preparation and storage of food.
    Physical Activity: Opportunities for regular exercise, whether it’s through recreational activities, sports, or simply safe walking spaces.
    Mental Wellbeing: Maintaining social relations and participation in social activities. E.g. group memberships, communication, costs of transport.
  • Morris, J. N., Donkin, A. J. M., Wonderling, D., Wilkinson, P., & Dowler, E. A. (2000). A minimum income for healthy living. Journal of Epidemiology & Community Health, 54(12), 885-889: https://jech.bmj.com/content/54/12/885
  • Morris, J. N., Wilkinson, P., Dangour, A. D., Deeming, C., & Fletcher, A. (2007). Defining a minimum income for healthy living (MIHL): older age, England. International journal of epidemiology, 36(6), 1300-1307: https://academic.oup.com/ije/article/36/6/1300/814933

Minimum Income Standards (MIS)

The concept of a “Minimum Income Standard” (MIS) in the UK is a research-driven approach to determining the income households need to achieve an acceptable standard of living. The MIS in the UK is based on research conducted by the Centre for Research in Social Policy (CRSP) at Loughborough University, in collaboration with the Joseph Rowntree Foundation. The Joseph Rowntree Foundation produces estimates of the MIS based on detailed consultations with members of the public to arrive at a level of income that makes a socially acceptable living standard affordable.

  • Basic Essentials: Food, clothing, housing, and heating.
  • Social Participation: The ability to engage in social activities, celebrate special occasions, and maintain relationships.
  • Unexpected Costs: Provision for unforeseen expenses, ensuring households aren’t vulnerable to sudden financial shocks.
  • Child-related Costs: For households with children, the MIS considers costs related to education, childcare, and recreational activities.

MIS budget totals have been calculated annually since 2008 for single, working age adults, working age couples, couples with two children, lone parents, single pensioners, pensioner couples. Further information and reports on Minimum Income Standards in the UK from the Joseph Rowntree Foundation can be found here: https://www.jrf.org.uk/living-standards/minimum-income-standards

Minimum cost of a healthy diet

The concept of the “cost of a healthy diet” refers to the estimated minimum expense required to obtain a diet that meets basic nutritional needs for maintaining good health. In Europe, researchers have conducted studies to determine the affordability of a healthy diet for the population. The findings reveal that in the majority of countries, over 10% of the population cannot afford the cost of a healthy diet.  These studies take into account factors such as food prices, dietary guidelines, and household income to calculate the minimum cost of a diet that meets nutritional recommendations. The estimates consider a range of food groups, including fruits, vegetables, whole grains, lean proteins, and dairy products.

  • Wiggins, S., Keats, S., Han, E., Shimokawa, S., Alberto, J., Hernández, V., & Clara, R. M. (2015). The rising cost of a healthy diet. Changing relative prices of foods in high-income and emerging economies. London: Overseas Development Institute: https://cdn.odi.org/media/documents/9580.pdf

‘Fuel poverty’ and health

The term ‘fuel poverty’ refers to when individuals or households are unable to afford sufficient heating to keep their homes adequately warm. This issue has significant implications for health, affecting people of all age groups. Fuel poverty has been ‘intimately’ linked to a range of poor health outcomes. Inadequate heating and living in cold environments can have direct health impacts, especially for vulnerable populations such as the elderly, young children, and individuals with pre-existing health conditions. Prolonged exposure to cold temperatures can lead to respiratory problems, cardiovascular issues, exacerbation of existing conditions, and increased susceptibility to infections. Additionally, living in fuel poverty may lead to social and psychological stressors, such as anxiety and depression, which can further impact overall well-being.

  • Wang, C., Wang, J., & Norbäck, D. (2022). A systematic review of associations between energy use, fuel poverty, energy efficiency improvements and health. International Journal of Environmental Research and Public Health, 19(12), 7393: https://www.mdpi.com/1660-4601/19/12/7393

‘Subjective financial situation’ and health

An alternative to income and expenditure based measures is the subjective financial situation experienced by a person or household.  Subjective financial situation is commonly measured using survey questions such as: “How well would you say you yourself are managing financially these days?”.  There is evidence that measures of subjective financial situation are differentially associated with health and wellbeing outcomes due to differences in personal needs for income and expenditure and subjective differences in social expectations and comparisons. Measures of subjective financial situation may be more strongly associated with health and wellbeing  than objective measures as they capture experienced vulnerability, anxiety about current and future financial hardship, and perceived affordability of participation in social and cultural activities that are important to quality of life and subjective wellbeing.

  • Arber, S., Fenn, K., & Meadows, R. (2014). Subjective financial well-being, income and health inequalities in mid and later life in Britain. Social Science & Medicine, 100, 12-20:

https://www.sciencedirect.com/science/article/pii/S0277953613005649?casa_token=jN9a4IRaM6EAAAAA:wEmmPdCAoVw4d8srPuNywPEh5Ww_k759USo-5Mu8_5rf94-ylaZOuK2l-bQBHYN4J5bE28FRsKg 

Expenditure based measures and health

Income based measures of poverty are used to represent the resources available for saving or expenditure, and are therefore directly influenced by policies such as taxation and benefits.  An alternative to income based measures are expenditure based measures of poverty which are used to represent how needs and wants are satisfied by consumption of goods and services and availability of resources over time.  For example, household expenditure below 60 % of the national median (for overall expenditure) and measures of relative expenditure on specific heath-related goods and services such as food and fuel. Income based measures are more sensitive to short-term shocks such as unemployment or illness, which may not have an impact on actual expenditure.  For these reasons, expenditure based measures better represent longer term circumstances and expectations, and therefore living standards. Moreover, there is evidence to suggest that expenditure based measures are more strongly related to subjective wellbeing than income based measures.

Multidimensional measures of poverty and health

Multidimensional measures of poverty offer a more nuanced perspective on poverty, moving beyond the traditional focus on income. This comprehensive approach takes into account a family’s entire material resources, encompassing not only their income but also the tangible assets they possess. Such a perspective provides a richer understanding of a household’s economic standing and, therefore, may be more representative of determinants of health at the household-level.  Additionally, the approach acknowledges the unavoidable financial burdens some families endure, which heighten their susceptibility to poverty. These burdens include the additional expenses associated with disabilities, the costs of childcare for working parents, and the financial commitments of rent or mortgage payments.