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A major part of the cost-of-living crisis, which is hitting whānau across Aotearoa New Zealand hard, is the cost-of-healthy-food crisis. Fruit and vegetable prices have increased at a much higher rate than unhealthy packaged foods, and the impact is being felt by low-, and increasingly middle-income households. Doubling the reach of Ka Ora, Ka Ako, the free, healthy school lunches programme, from one quarter to at least half of all school children, is an obvious and readily available policy response to New Zealand’s unacceptably high household food insecurity.    

Rising cost of healthy food

From June 2014 to March 2023, Stats NZ reported that the price of healthy foods increased by 37%, and fruit and vegetables by 42%. In comparison, unhealthy packaged foods and drinks increased by 20% over the same period. Fruit and vegetable prices increased by 21% in 2023 alone, compared to 12% for general grocery items.

These cost increases have occurred alongside rents increasing to a record high, while minimum wages remain below the living wage.1 As outlined in the recent Growing Up in New Zealand analysis, food insecurity is now reaching into some middle income households. Half​ of the 12 year olds living in moderately food insecure households and a third​ of those in severely food insecure homes did not attend schools in the Ka Ora, Ka Ako programme.2

In a public opinion poll commissioned by Health Coalition Aotearoa, the cost of healthy food was rated the most urgent cost of living issue (83% ranked it in their top three issues that the government needed to address) and two-thirds of respondents supported doubling Ka Ora, Ka Ako.

The data illustrates a clear need for short-term interventions to help people access healthy food right now, alongside long-term, structural changes to reverse the huge impacts of social inequities on population health.

Ka Ora, Ka Ako – A powerful policy option

The Government is acutely aware of the cost-of-living crisis and is seeking 'bread and butter' actions to support the large number of households struggling to make ends meet. An obvious action, which is sitting on the Minister of Education's desk right now, is to at least double the reach of the free, healthy school lunch programme, Ka Ora, Ka Ako. This programme was introduced for the quarter of primary, intermediate and secondary schools with the highest level of disadvantage according to the Ministry of Education's Equity Index.

The Health Coalition Aotearoa recently released a petition to at least double Ka Ora, Ka Ako. We based the call on strong community support, as well as emerging evidence of the benefits of the programme and the large proportion of children from food insecure households whose schools are not covered by the programme. Readers who support this expansion are strongly encouraged to sign the petition.

screenshot of healthy lunches petitition

Evaluations of Ka Ora, Ka Ako have shown that the programme reduces the number of hungry children at school, improves nutrition, and improves overall well-being through increases in physical, social, emotional and school functioning. This demonstrates that the programme, launched in 2019 and expanded to respond to acute food insecurity during the Covid lockdowns, has many wide-reaching positive impacts for children and their whānau.

Paradoxically, most children facing household food insecurity aren’t covered by the programme. Three-quarters of schools are ineligible despite having many students from households struggling to provide healthy kai on a regular basis. This is especially the case for secondary schools because of their wide catchment areas. A survey3 of 41 schools in Hawke’s Bay found that ‘food insufficiency’ (i.e. student-reported ‘Food ran out at home’ or ‘Went hungry as not enough food at home’) was common in students at schools across the full range of the Equity Index. For primary schools, the prevalence was 29% for Year 5 students in schools receiving Ka Ora, Ka Ako compared to 14% in schools not receiving Ka Ora, Ka Ako. For secondary schools, food insufficiency was similar for Year 9 students at schools receiving (12%) or not receiving (14%) the programme.

The investment needed to double the reach of Ka Ora, Ka Ako (about $250m/year) should be considered high value-for-investment because of the multiple benefits of the programme. The Government also has the option to offset some of this cost with health promotion taxes which are recommended, at least for sugary drinks, by the World Health Organisation4, World Bank5 and many expert reports.6

Addressing the cost-of-healthy-food crisis long-term

Expanding Ka Ora, Ka Ako is one of the best, immediate actions the Government can take to ease the pressure for whānau doing it hardest. However, longer term solutions to food insecurity and the ever-growing gap between the cost of healthy and unhealthy foods will require deeper structural changes.  A bold vision for a healthy, equitable, sustainable and prosperous food system, and a national food and nutrition strategy to help us get there, should be a high priority for our next government. This strategy should consider, for example, fiscal levers that increase the affordability of healthy food, account for the social costs of unhealthy packaged foods and drinks, incentives to produce food locally for local communities, and more equitable means of income distribution.

What is new in this Briefing

  • The most concerning part of the current cost-of-living crisis is the cost-of-healthy-food crisis as inflationary price increases are far greater for healthy compared to unhealthy foods.
  • A clear, immediate policy response should be to at least double the reach of the government’s free, healthy lunch programme, Ka Ora, Ka Ako

Implications for public health

  • Food insecurity and unhealthy diets among children create a high risk to their health and wellbeing and the recent soaring cost of healthy food is exacerbating this risk.
  • Based on local and international evidence, expanding Ka Ora Ka Ako will likely have multiple health, economic and environmental benefits at the level of the child, whānau, school, community and food system.

Author details:
Professor Boyd Swinburn, School of Population Health, University of Auckland, and Co-Chair, Health Coalition Aotearoa 
Dr Sally MackaySenior Lecturer, Epidemiology and Biostatistics, University of Auckland
Associate Professor Lisa Te Morenga
Research Centre for Hauora and Health, Massey University, and Co-Chair, Health Coalition Aotearoa 

Conflict of interest statement: Authors do not have competing interests.  

Featured image: Ka OraKa Ako | Healthy School Lunches programme

Public Health Expert Briefing (ISSN 2816-1203)


  1. Waldegrave, C., Rogers, E., Nguyen, G. Report of a Measurement Review for a Living Wage. Family Centre Social Policy Research Unit. April 2023.
  2. Gerritsen, S., Park, A., Wall, C., Napier, C., Exeter, D., Paine SJ. 2023. Now We Are Twelve: Food Insecurity. Snapshot 3. Auckland: Growing Up in New Zealand. Available from:
  3. McKelvie-Sebileau P, Gerritsen S, Swinburn B, D’Souza E, Tipene-Leach D. Nourishing Hawke’s Bay: He wairua tō te kai – food security, health behaviours and wellbeing in children in regional New Zealand. J Royal Soc NZ. 2022.
  4. WHO manual on sugar-sweetened beverage taxation policies to promote healthy diets. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO
  5. Hattersley L, Thiebaud A, Fuchs A, Gonima A, Silver L, Mandeville K. Taxes On Sugar- Sweetened Beverages: International Evidence And Experiences. World Bank Group Knowledge Brief. 2020.
  6. von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD012292. DOI: 10.1002/14651858.CD012292.pub2


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Public health expert commentary and analysis on the challenges facing Aotearoa New Zealand and evidence-based solutions.


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