The Ministry of Health has established a regulatory committee to promote a healthier food environment, making it easier for consumers to choose healthy foods according to distinctive package labels. This is part of a broader national program, EfshariBari (Health is Possible), for active, healthy living designed to create an environment facilitating and fostering a culture of health, to establish the principles of active, healthy living as social norms, and to encourage behavioral change.
Thus, since January 2020 packaged foods have appeared with highly visible labels: Foods corresponding to the Mediterranean diet that is recommended in Israel are labeled green whereas foods high in sugar, salt, or saturated fat content are labeled red. The purpose of the labels is to make nutritional information readily available to the public and encourage wise choices in the purchase and consumption of healthy foods.
To help evaluate the new labeling program, the Ministry of Health asked the Myers-JDC-Brookdale Institute to conduct a survey of the general population.
- To examine the purchasing habits and frequency of consumption of both healthy and unhealthy foods prior to the launching of the labeling program
- To examine public attitudes to the labeling and the possibility of taxation of unhealthy foods
- To create a basis for comparison between the period preceding the onset of labeling and the period following it
The study population comprised Israel’s total population aged 22+. Of a sample of approximately 1,800 people, 944 responded to the questionnaire (52% response rate).
The questionnaire probed food purchase, the frequency of consumption of unhealthy foods (which meet the criteria for red labels), and of healthy foods (which meet the criteria for the green label), as well as questions on lifestyle, attitudes to the labeling reform, and to taxation of unhealthy foods. For the Arab population, the questionnaire was translated into Arabic and adjusted for cultural differences where relevant.
The data were collected on the eve of labeling, from September 2019 to January 2020. Respondents were interviewed by telephone; the interviews, in Hebrew or Arabic, lasted about half an hour.
The data analysis and presentation of findings stressed the differences between ultra-Orthodox Jews (hereafter UOJ), non-ultra Orthodox Jews (non-UOJ), and Arabs; between households with or without children under 13 (hereafter, young families); and between households with an income assessed as “well below average” (hereafter low-income families) and other households.
Purchase of unhealthy foods, meeting the criteria for red labels
Respondents were asked about their purchasing habits, by specific products: e.g., “Are you in the habit of purchasing yellow cheese [or another product]?” In general, a high percentage replied that they do purchase unhealthy foods that meet the criteria for red labels. The most common products in this category were yellow or hard cheese (purchased by 88% of households), salty snacks (77%), ketchup (72%), and sweets (70%).
For some products, such as sweet beverages, sweetened dairy items and snacks, a higher percentage of purchase was found among Arab households than Jewish ones, and among UOJ than non-UOJ households. Similarly, the purchase of all unhealthy products cited in the survey was greater among young families than other households. The gap in purchase between young and other families was particularly wide for products usually marketed to children, such as salty snacks (92% vs 61%, respectively), sweetened dairy items (73% vs 43%, respectively), and sweet morning cereals (52% vs 22%, respectively). On the other hand, the percentage of purchase of some unhealthy products was lower among low-income than other households.
Purchase of healthy foods, meeting the criteria for the green label
A very high percentage of respondents said that they were in the habit of purchasing the healthy products cited in the questionnaire: 99% reported buying fruit, vegetables and eggs, 94% – poultry, 85% – legumes, and 74% – nuts. Young families had a higher purchase percentage of fresh poultry, and a lower one of nuts, than other households.
No significant differences were found between Arabs, UOJs and non-UOJs; or between low-income and other households with the exception that a lower percentage of the former purchased legumes.
Frequency of consumption
Survey participants were asked about the frequency of the household’s weekly consumption of various foods. Those that reported a product’s consumption at a frequency of thrice weekly or more were defined as “heavy consumers” of that product. The most common unhealthy foods consumed were hard cheeses and sweet snacks. About a third of the households consumed these two items (36% and 33%, respectively( often (thrice weekly or more); 25% often consumed sweet beverages; and some 20% often consumed salty snacks, ketchup, sweet baked goods, and dairy items. The most common healthy products consumed were fruit and vegetables: Of these, 88% and 97%, respectively, were consumed often. Eggs were consumed often by 70%; nuts – by 41%; and legumes – by 27%.
The examination of households that consumed unhealthy foods often, by population group, revealed that a higher percentage of Arab than Jewish ones often consumed sweet beverages (55% vs 16% of UOJs and 21% of non-UOJs, respectively); salty snacks (38% vs 15% and 17%, respectively); sweet dairy items (37% vs 18% and 22%, respectively); and processed meats (19% vs 3% and 10%, respectively). We also found that a relatively high percentage of UOJs (40%) often consumed ketchup versus Arab households (27%), and non-UOJs (16%).
A higher percentage of low-income than other families often consumed sweet beverages, and a lower percentage of low-income households often consumed fruit.
A higher percentage of young than other families often consumed hard cheese, sweet cereals, salty snacks, ketchup, sweet dairy items, and “regular” cornflakes. A higher percentage of young families also often consumed poultry and eggs, and a lower percentage of them often consumed nuts.
Attitudes to food labeling
Respondents were asked about the importance of the food labeling program, the meaning of the labels, and how they expected the labels to impact on their household purchases.
Some 90% agreed to a great or very great extent that the food labeling program is important. In this respect, no differences were found between the population groups considered in this study.
Of the total respondents, 35% agreed with the statement that “It is recommended that red-labeled foods not be eaten at all,” which represents the stance of the Ministry of Health. Higher percentages of UOJ and Arab households agreed with the statement (40% and 47%, respectively, vs 33% of non-UOJ households). A lower percentage of young families (27%) than other households agreed with the statement.
Similarly, 55% of the total respondents agreed that: “All the foods that the Ministry of Health chose to label ‘red’ are unhealthy.” Higher percentages of UOJ and Arab households than non-UOJ respondents agreed with the statement (69% and 60%, respectively, vs 52% of non-UOJ households).
On the other hand, 13% of all respondents agreed that: “Green-labeled foods may be eaten without limit,” reflecting a misconception of the significance of labeling. Here, too, higher percentages of UOJ and Arab households agreed with the statement (19% and 25%, respectively, vs 11% of non-UOJ households).
As regards the expected impact of labeling on the purchase of healthy and unhealthy foods, 64% of the respondents forecast that they would purchase less “red foods.” This projected change was particularly striking among UOJ households (76%) and Arab households (75%) versus non-UOJ households (61%), and among low-income households than other households (72% vs 61%, respectively).
Of all the respondents, 46% agreed that they “will purchase more green-labeled foods.” Again, the projected change was more striking among UOJ (60%) and Arab (51%) households than non-UOJ households (43%), and households with young children (55%) than other households (42%).
Public attitudes to taxation of unhealthy food products
Respondents were asked about the hypothetical possibility of the imposition of taxes on unhealthy foods, and the impact that this could have on the extent of their purchase of such items. Some 60% judged that taxation could have a beneficial impact on public health and lead to a decrease in the general purchase of unhealthy foods. Asked directly whether they supported taxation, only 40% expressed support. However, this support increased to 56% when taxation was presented in tandem with the lowering of prices for heathy foods.
A high percentage (83%) of respondents agreed that “healthy food is more expensive than unhealthy food.” The percentage was lower among Arab households (71%) than Jewish ones (85%), and among young families (79%) than other households.
Conclusion and Recommendations
The results of the survey showed that high percentages of the population do purchase and consume healthy foods, such as vegetables, fruit, eggs and poultry. Virtually no differences were found between the various population groups as regards the consumption of healthy foods. It appears that the general population has access to the healthy food products cited in the survey.
At the same time, we found that a high percentage of the households purchase and consume unhealthy food. Thus, it seems that programs designed to change public consumption behavior should emphasize the importance of reducing the consumption of unhealthy foods (rather than focusing on encouraging consumption of healthy foods). According to the survey findings, population groups with a high percentage of household consumption of unhealthy foods are Arabs, UOJs, and young families. It is recommended that the efforts to change consumption behavior focus on these groups.
The findings indicate the public’s acceptance of food labeling. A high percentage of respondents deemed the program important to a great or very great extent. No substantial differences were found between the population groups in their perception of the program’s importance. Moreover, a high percentage of respondents (64%) reported their intent to change their behavior in wake of the labeling, i.e., to purchase less red-labeled foods and more green-labeled foods. The readiness for behavioral change is relatively high among groups, which, according to the findings, show a high percentage of consumption of unhealthy foods (UOJs, Arabs, and young families). It may well be that consumers who judged that they would not change their behavior believe that they already purchase few red-labeled foods or a good deal of green-labeled ones.
Some respondents, however, misconceived the significance of labeling: 25% of Arab respondents and some 20% of UOJ respondents expressed the belief that green-labeled foods may be eaten without limit although the recommendation is that they be eaten in moderation as part of a balanced diet. Some respondents also had reservations about the red labeling. Only 35% agreed with the approach of the Ministry of Health that red-labeled foods should not be eaten at all, and 55% agreed that all red-labeled products are unhealthy. Publicity campaigns or school programs should emphasize the Mediterranean diet, its components, and the significance of the labels.
A high percentage of the respondents (83%) expressed the belief that healthy food is costlier than unhealthy food even though most of the population does purchase and consume healthy food corresponding to the Mediterranean diet. Here too, publicity campaigns should emphasize the components of a healthy diet and ways to construct this type of menu on a low budget.
The study included a preliminary examination of public attitudes towards the taxation of unhealthy foods, and how this could affect their behavior. Some 60% judged that taxation would be beneficial to public health and lead to a decrease in the general extent of unhealthy foods purchased. Nonetheless, there may be a discrepancy between public attitudes and actual public behavior, especially in connection with financial aspects.
The study was initiated by the Nutrition Department of the Ministry of Health.