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Affiliation(s)
- Asha Kaur
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention, University of Oxford, Headington, Oxford OX3 7LF, UK
| | - Adam D M Briggs
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention, University of Oxford, Headington, Oxford OX3 7LF, UK
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Capacci S, Allais O, Bonnet C, Mazzocchi M. The impact of the French soda tax on prices and purchases. An ex post evaluation. PLoS One 2019; 14:e0223196. [PMID: 31603901 PMCID: PMC6788734 DOI: 10.1371/journal.pone.0223196] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/15/2019] [Indexed: 11/18/2022] Open
Abstract
We estimate the price and consumption effects of the 2012 French tax on sweetened non-alcoholic drinks using a difference-in-difference approach. Our identification strategy exploits Italian data as a natural control group. We use French and Italian Consumer Price Indices, purchase prices and quantities from the 2011 and 2012 Kantar and GfK home-scan surveys for two French regions and two neighbouring Italian regions, and expenditure data from the 2011 and 2012 Italian Expenditure Survey. We check for the robustness of our results by applying the difference-in-difference models using only French data and considering water as the benchmark (control) good. We find that the tax is transmitted to the prices of taxed drinks, with full transmission for soft drinks and partial transmission for fruit juices. The evidence on purchase responses is mixed and less robust, indicating at most a very small reduction in soft drink purchases (about half a litre per capita per year), an impact which would be consistent with the low tax rate. We find suggestive evidence of a larger response by the sub-sample of heavy purchasers. Fruit juices and water do not seem to have been affected by the tax.
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Affiliation(s)
- Sara Capacci
- Affiliation Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Olivier Allais
- Affiliation Institut National de la Recherche Agronomique (INRA), UR1303 ALISS, Ivry-sur-Seine, France
| | - Celine Bonnet
- Affiliation Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France
| | - Mario Mazzocchi
- Affiliation Department of Statistical Sciences, University of Bologna, Bologna, Italy
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Fooks GJ, Williams S, Box G, Sacks G. Corporations' use and misuse of evidence to influence health policy: a case study of sugar-sweetened beverage taxation. Global Health 2019; 15:56. [PMID: 31551086 PMCID: PMC6760066 DOI: 10.1186/s12992-019-0495-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/01/2019] [Indexed: 01/11/2023] Open
Abstract
Background Sugar sweetened beverages (SSB) are a major source of sugar in the diet. Although trends in consumption vary across regions, in many countries, particularly LMICs, their consumption continues to increase. In response, a growing number of governments have introduced a tax on SSBs. SSB manufacturers have opposed such taxes, disputing the role that SSBs play in diet-related diseases and the effectiveness of SSB taxation, and alleging major economic impacts. Given the importance of evidence to effective regulation of products harmful to human health, we scrutinised industry submissions to the South African government’s consultation on a proposed SSB tax and examined their use of evidence. Results Corporate submissions were underpinned by several strategies involving the misrepresentation of evidence. First, references were used in a misleading way, providing false support for key claims. Second, raw data, which represented a pliable, alternative evidence base to peer reviewed studies, was misused to dispute both the premise of targeting sugar for special attention and the impact of SSB taxes on SSB consumption. Third, purposively selected evidence was used in conjunction with other techniques, such as selective quoting from studies and omitting important qualifying information, to promote an alternative evidential narrative to that supported by the weight of peer-reviewed research. Fourth, a range of mutually enforcing techniques that inflated the effects of SSB taxation on jobs, public revenue generation, and gross domestic product, was used to exaggerate the economic impact of the tax. This “hyperbolic accounting” included rounding up figures in original sources, double counting, and skipping steps in economic modelling. Conclusions Our research raises fundamental questions concerning the bona fides of industry information in the context of government efforts to combat diet-related diseases. The beverage industry’s claims against SSB taxation rest on a complex interplay of techniques, that appear to be grounded in evidence, but which do not observe widely accepted approaches to the use of either scientific or economic evidence. These techniques are similar, but not identical, to those used by tobacco companies and highlight the problems of introducing evidence-based policies aimed at managing the market environment for unhealthful commodities. Electronic supplementary material The online version of this article (10.1186/s12992-019-0495-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gary Jonas Fooks
- School of Humanities and Social Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Simon Williams
- School of Humanities and Social Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Graham Box
- School of Law, University of Reading, Reading, Berkshire, RG6 6AH, UK
| | - Gary Sacks
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, 3125, Australia
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Scheelbeek PFD, Cornelsen L, Marteau TM, Jebb SA, Smith RD. Potential impact on prevalence of obesity in the UK of a 20% price increase in high sugar snacks: modelling study. BMJ 2019; 366:l4786. [PMID: 31484641 PMCID: PMC6724407 DOI: 10.1136/bmj.l4786] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks. DESIGN Modelling study. SETTING General adult population of the United Kingdom. PARTICIPANTS 36 324 households with data on product level household expenditure from UK Kantar FMCG (fast moving consumer goods) panel for January 2012 to December 2013. Data were used to estimate changes in energy (kcal, 1 kcal=4.18 kJ=0.00418 MJ) purchase associated with a 20% price increase in high sugar snacks. Data for 2544 adults from waves 5 to 8 of the National Diet and Nutrition Survey (2012-16) were used to estimate resulting changes in BMI and prevalence of obesity. MAIN OUTCOME MEASURES The effect on per person take home energy purchases of a 20% price increase for three categories of high sugar snacks: confectionery (including chocolate), biscuits, and cakes. Health outcomes resulting from the price increase were measured as changes in weight, BMI (not overweight (BMI <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30)), and prevalence of obesity. Results were stratified by household income and BMI. RESULTS For income groups combined, the average reduction in energy consumption for a 20% price increase in high sugar snacks was estimated to be 8.9×103 kcal (95% confidence interval -13.1×103 to -4.2×103 kcal). Using a static weight loss model, BMI was estimated to decrease by 0.53 (95% confidence interval -1.01 to -0.06) on average across all categories and income groups. This change could reduce the UK prevalence of obesity by 2.7 percentage points (95% confidence interval -3.7 to -1.7 percentage points) after one year. The impact of a 20% price increase in high sugar snacks on energy purchase was largest in low income households classified as obese and smallest in high income households classified as not overweight. CONCLUSIONS Increasing the price of high sugar snacks by 20% could reduce energy intake, BMI, and prevalence of obesity. This finding was in a UK context and was double that modelled for a similar price increase in sugar sweetened beverages.
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Affiliation(s)
- Pauline F D Scheelbeek
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard D Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
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Muhammad A, Meade B, Marquardt DR, Mozaffarian D. Global patterns in price elasticities of sugar-sweetened beverage intake and potential effectiveness of tax policy: a cross-sectional study of 164 countries by sex, age and global-income decile. BMJ Open 2019; 9:e026390. [PMID: 31399449 PMCID: PMC6701823 DOI: 10.1136/bmjopen-2018-026390] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To quantify global relationships between sugar-sweetened beverage (SSB) intake and prices and examine the potential effectiveness of tax policy. DESIGN SSB intake data by country, age and sex from the Global Dietary Database were combined with gross domestic product and price data from the World Bank. Intake responsiveness to income and prices was estimated accounting for national income, age and sex differences. SETTING 164 countries. POPULATION Full adult population in each country. MAIN OUTCOME MEASURES A consumer demand modelling framework was used to estimate the relationship between SSB intake and prices and derive own-price elasticities (measures of percentage changes in intake from a 1% price change) globally by age and sex. We simulated how a 20% tax would impact SSB intake globally. Tax policy outcomes were examined across countries by global income decile for representative age and sex subgroups. RESULTS Own-price responsiveness was highest in lowest income countries, ranging from -0.70 (p<0.100) for women, age 50, to -1.91 (p<0.001) for men, age 80. In the highest income countries, responsiveness was as high as -0.49 (p<0.001) (men, age 20), but was mostly insignificant for older adults. Overall, elasticities were strongest (more negative) at the youngest and oldest age groups, and mostly insignificant for middle-aged adults, particularly in middle-income and high-income countries. Sex differences were mostly negligible. Potential intake reductions from a 20% tax in lowest income countries ranged from 14.5% (95% CI: 29.5%, -0.4%) in women, 35 ≤ age < 60, to 24.9% (44.4%, 5.3%) in men, age ≥60. Intake reductions decreased with country income overall, and were mostly insignificant for middle-aged adults. CONCLUSIONS These findings estimate the global price-responsiveness of SSB intake by age and sex, informing ongoing policy discussions on potential effects of taxes.
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Affiliation(s)
- Andrew Muhammad
- University of Tennessee Institute of Agriculture, Knoxville, Tennessee, USA
| | - Birgit Meade
- USDA Economic Research Service, Washington, DC, USA
| | | | - Dariush Mozaffarian
- Tufts University Friedman School of Nutrition Science and Policy, Boston, Massachusetts, USA
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Comprehensive Approaches to Improving Nutrition: Future Prospects. Nutrients 2019; 11:nu11081760. [PMID: 31370182 PMCID: PMC6723295 DOI: 10.3390/nu11081760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 12/17/2022] Open
Abstract
When it comes to nutrition, nearly everyone has an opinion. In the past, nutrition was considered to be an individual's responsibility, however, more recently governments have been expected (by some) to share that responsibility by helping to ensure that marketing is responsible, and that food chains offer healthy meal choices in addition to their standard fare, for example. In some countries, governments have gone as far as to remove tax from unprocessed foods or to introduce taxes, such as that imposed on sugary soft drinks in the UK, Mexico, France and Norway. Following on from the sugar tax, chocolate might be next! Is this the answer to our burgeoning calorie intake and increasing poor nutritional status, or is there another approach? In this narrative we will focus on some of the approaches taken by communities and governments to address excess calorie intake and improve nutritional status, as well as some of the conflicts of interest and challenges faced with implementation. It is clear that in order to achieve meaningful change in the quality of nutritional intake and to reduce the long-term prevalence of obesity, a comprehensive approach is required wherein governments and communities work in genuine partnership. To take no or little action will doom much of today's youth to a poor quality of life in later years, and a shorter life expectancy than their grandparents.
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Marteau TM, White M, Rutter H, Petticrew M, Mytton OT, McGowan JG, Aldridge RW. Increasing healthy life expectancy equitably in England by 5 years by 2035: could it be achieved? Lancet 2019; 393:2571-2573. [PMID: 31258113 DOI: 10.1016/s0140-6736(19)31510-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Theresa M Marteau
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK.
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Mark Petticrew
- Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London UK
| | - Oliver T Mytton
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - James G McGowan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
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Saha S, Nordström J, Mattisson I, Nilsson PM, Gerdtham UG. Modelling the Effect of Compliance with Nordic Nutrition Recommendations on Cardiovascular Disease and Cancer Mortality in the Nordic Countries. Nutrients 2019; 11:nu11061434. [PMID: 31242671 PMCID: PMC6627195 DOI: 10.3390/nu11061434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
The objective of this study is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in the Nordic countries, i.e., Sweden, Denmark, Finland, Norway, and Iceland, if adults adhere to the Nordic Nutrition Recommendations (NNR). A sex- and age-group specific epidemiological macro-simulation model was used to estimate the preventable deaths due to the differences between country specific actual intake and recommended intake of changes in food components. Data included in the model are a baseline scenario (actual dietary intake), a counterfactual scenario (recommended intake), and age-and sex-specific mortality for cardiovascular and diet-related cancer diseases, together with the total population risk of a specific year. Monte Carlo analyses with 5000 iterations were performed to produce the 95% uncertainty intervals. The model predicts that Iceland would benefit the most by adhering to the NNR, followed by Finland. In all the Nordic countries, the highest benefit would be achieved by adhering to the fruits and vegetable intakes, except Denmark, where a lower recommended intake of salt would provide the highest benefit. For men, fruits and vegetables could have saved more lives compared to other dietary components for all the Nordic countries, while for women, dietary fiber was the most prominent factor, except in Iceland. The Nordic Council should consider policies for promoting healthy eating according to the needs of each country.
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Affiliation(s)
- Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, SE-22381 Lund, Sweden.
| | - Jonas Nordström
- School of Economics and Management, Agrifood Economics Centre, Lund University, SE-22007 Lund, Sweden.
- Department of Food and Resource Economics, University of Copenhagen, DK-1958 Frederiksberg C, Denmark.
| | | | - Peter M Nilsson
- Department of Internal Medicine, Skane University Hospital, SE-20502 Malmo, Sweden.
- Department of Clinical Sciences (Malmo), Lund University, SE-20502 Malmo, Sweden.
| | - Ulf-G Gerdtham
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, SE-22381 Lund, Sweden.
- Department of Economics, Lund University, SE-22363 Lund, Sweden.
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Following in the footsteps of tobacco and alcohol? Stakeholder discourse in UK newspaper coverage of the Soft Drinks Industry Levy. Public Health Nutr 2019; 22:2317-2328. [PMID: 31111808 DOI: 10.1017/s1368980019000739] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In politically contested health debates, stakeholders on both sides present arguments and evidence to influence public opinion and the political agenda. The present study aimed to examine whether stakeholders in the Soft Drinks Industry Levy (SDIL) debate sought to establish or undermine the acceptability of this policy through the news media and how this compared with similar policy debates in relation to tobacco and alcohol industries. DESIGN Quantitative and qualitative content analysis of newspaper articles discussing sugar-sweetened beverage (SSB) taxation published in eleven UK newspapers between 1 April 2015 and 30 November 2016, identified through the Nexis database. Direct stakeholder citations were entered in NVivo to allow inductive thematic analysis and comparison with an established typology of industry stakeholder arguments used by the alcohol and tobacco industries. SETTING UK newspapers. PARTICIPANTS Proponents and opponents of SSB tax/SDIL cited in UK newspapers. RESULTS Four hundred and ninety-one newspaper articles cited stakeholders' (n 287) arguments in relation to SSB taxation (n 1761: 65 % supportive and 35 % opposing). Stakeholders' positions broadly reflected their vested interests. Inconsistencies arose from: changes in ideological position; insufficient clarity on the nature of the problem to be solved; policy priorities; and consistency with academic rigour. Both opposing and supportive themes were comparable with the alcohol and tobacco industry typology. CONCLUSIONS Public health advocates were particularly prominent in the UK newspaper debate surrounding the SDIL. Advocates in future policy debates might benefit from seeking a similar level of prominence and avoiding inconsistencies by being clearer about the policy objective and mechanisms.
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61
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Dunstan J, Aguirre M, Bastías M, Nau C, Glass TA, Tobar F. Predicting nationwide obesity from food sales using machine learning. Health Informatics J 2019; 26:652-663. [PMID: 31106648 DOI: 10.1177/1460458219845959] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The obesity epidemic progresses everywhere across the globe, and implementing frequent nationwide surveys to measure the percentage of obese population is costly. Conversely, country-level food sales information can be accessed inexpensively through different suppliers on a regular basis. This study applies a methodology to predict obesity prevalence at the country-level based on national sales of a small subset of food and beverage categories. Three machine learning algorithms for nonlinear regression were implemented using purchase and obesity prevalence data from 79 countries: support vector machines, random forests and extreme gradient boosting. The proposed method was validated in terms of both the absolute prediction error and the proportion of countries for which the obesity prevalence was predicted satisfactorily. We found that the most-relevant food category to predict obesity is baked goods and flours, followed by cheese and carbonated drinks.
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Amies-Cull B, Briggs ADM, Scarborough P. Estimating the potential impact of the UK government's sugar reduction programme on child and adult health: modelling study. BMJ 2019; 365:l1417. [PMID: 30996021 PMCID: PMC6468887 DOI: 10.1136/bmj.l1417] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the impact of the UK government's sugar reduction programme on child and adult obesity, adult disease burden, and healthcare costs. DESIGN Modelling study. SETTING Simulated scenario based on National Diet and Nutrition Survey waves 5 and 6, England. PARTICIPANTS 1508 survey respondents were used to model weight change among the population of England aged 4-80 years. MAIN OUTCOME MEASURES Calorie change, weight change, and body mass index change were estimated for children and adults. Impact on non-communicable disease incidence, quality adjusted life years, and healthcare costs were estimated for adults. Changes to disease burden were modelled with the PRIMEtime-CE Model, based on the 2014 population in England aged 18-80. RESULTS If the sugar reduction programme was achieved in its entirety and resulted in the planned sugar reduction, then the calorie reduction was estimated to be 25 kcal/day (1 kcal=4.18 kJ=0.00418 MJ) for 4-10 year olds (95% confidence interval 23 to 26), 25 kcal/day (24 to 28) for 11-18 year olds, and 19 kcal/day (17 to 20) for adults. The reduction in obesity could represent 5.5% of the baseline obese population of 4-10 year olds, 2.2% of obese 11-18 year olds, and 5.5% of obese 19-80 year olds. A modelled 51 729 quality adjusted life years (95% uncertainty interval 45 768 to 57 242) were saved over 10 years, including 154 550 (132 623 to 174 604) cases of diabetes and relating to a net healthcare saving of £285.8m (€332.5m, $373.5m; £249.7m to £319.8m). CONCLUSIONS The UK government's sugar reduction programme could reduce the burden of obesity and obesity related disease, provided that reductions in sugar levels and portion sizes do not prompt unanticipated changes in eating patterns or product formulation.
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Affiliation(s)
- Ben Amies-Cull
- Centre for Population Approaches to Non-Communicable Disease Prevention, Big Data Institute, University of Oxford, Headington, Oxford OX3 7FZ, UK
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Adam D M Briggs
- Centre for Population Approaches to Non-Communicable Disease Prevention, Big Data Institute, University of Oxford, Headington, Oxford OX3 7FZ, UK
| | - Peter Scarborough
- Centre for Population Approaches to Non-Communicable Disease Prevention, Big Data Institute, University of Oxford, Headington, Oxford OX3 7FZ, UK
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
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Cornelsen L, Mazzocchi M, Smith RD. Fat tax or thin subsidy? How price increases and decreases affect the energy and nutrient content of food and beverage purchases in Great Britain. Soc Sci Med 2019; 230:318-327. [PMID: 31030908 DOI: 10.1016/j.socscimed.2019.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Laura Cornelsen
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, United Kingdom.
| | - Mario Mazzocchi
- Department of Statistical Sciences, University of Bologna, Via Belle Arti 41, Bologna, Italy
| | - Richard D Smith
- College of Medicine and Health, University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, United Kingdom; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, United Kingdom
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64
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Prevention of Cardiovascular Disease and Cancer Mortality by Achieving Healthy Dietary Goals for the Swedish Population: A Macro-Simulation Modelling Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050890. [PMID: 30870975 PMCID: PMC6427376 DOI: 10.3390/ijerph16050890] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 12/03/2022]
Abstract
The objective is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in Sweden if adults adhere to the official dietary recommendations. We used an age-group and sex-specific epidemiological macro-simulation model to estimate preventable deaths due to the discrepancies between actual intake and recommended intake of changes in food components. Data included in the model are a baseline scenario (actual dietary intake), a counterfactual scenario (recommended intake) and age- and sex-specific mortality for cardiovascular and diet-related cancer diseases together compared with the total population risk of a specific year. Monte Carlo analyses with 5000 iterations was performed to produce the 95% uncertainty intervals (UI). The model predicts that 6405 (95% UI: 5086–7086) deaths could be prevented or delayed if the Swedish population could adhere to official dietary recommendations in a year. More deaths would be saved for men than women. The recommendations for fruits and vegetables could have saved 47% of the deaths, followed by fiber intake (32%). For men, fruits and vegetables could have saved more compared to other dietary components, while for women dietary fiber was the prominent factor. Public health policies should consider ensuring healthy eating practices for the Swedish population.
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Blake MR, Lancsar E, Peeters A, Backholer K. Sugar-sweetened beverage price elasticities in a hypothetical convenience store. Soc Sci Med 2019; 225:98-107. [PMID: 30822609 DOI: 10.1016/j.socscimed.2019.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/30/2019] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Abstract
An increase in sugar-sweetened beverage (SSB) prices has been suggested to reduce SSB intake to improve population health. Using a discrete choice experiment, we tested the effect of price changes on beverage choices in an online hypothetical convenience store setting amongst 1,008 Australian adults in May to June 2016. From this we calculated pre-packaged beverage price elasticities overall and for health policy-target consumer subgroups; and identified consumer subgroups likely to be most reactive to beverage price changes. Using mixed logit analysis, we found similar price elasticities for age, gender and income groups. More frequent SSB consumers tended to be less sensitive to SSB price changes. Latent class analysis revealed five consumer groups, none of which fit the desirable policy-target of highly price sensitive, frequent SSB consumers. An improved understanding of responsiveness to beverage price changes and consumer preferences could improve predictions of whose health is likely to benefit most from pricing interventions.
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Affiliation(s)
- Miranda R Blake
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Australia.
| | - Emily Lancsar
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, Australia; Centre for Health Economics, Monash University, Clayton, Australia.
| | - Anna Peeters
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Australia.
| | - Kathryn Backholer
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Australia.
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Park H, Yu S. Policy review: Implication of tax on sugar-sweetened beverages for reducing obesity and improving heart health. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2018.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wilde P, Huang Y, Sy S, Abrahams-Gessel S, Jardim TV, Paarlberg R, Mozaffarian D, Micha R, Gaziano T. Cost-Effectiveness of a US National Sugar-Sweetened Beverage Tax With a Multistakeholder Approach: Who Pays and Who Benefits. Am J Public Health 2019; 109:276-284. [PMID: 30571305 PMCID: PMC6336039 DOI: 10.2105/ajph.2018.304803] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To estimate the health impact and cost-effectiveness of a national penny-per-ounce sugar-sweetened beverage (SSB) tax, overall and with stratified costs and benefits for 9 distinct stakeholder groups. METHODS We used a validated microsimulation model (CVD PREDICT) to estimate cardiovascular disease reductions, quality-adjusted life years gained, and cost-effectiveness for US adults aged 35 to 85 years, evaluating full and partial consumer price pass-through. RESULTS From health care and societal perspectives, the SSB tax was highly cost-saving. When we evaluated health gains, taxes paid, and out-of-pocket health care savings for 6 distinct consumer categories, incremental cost-effectiveness ratios ranged from $20 247 to $42 662 per quality-adjusted life year for 100% price pass-through (incremental cost-effectiveness ratios similar with 50% pass-through). For the beverage industry, net costs were $0.92 billion with 100% pass-through (largely tax-implementation costs) and $49.75 billion with 50% pass-through (largely because of partial industry coverage of the tax). For government, the SSB tax positively affected both tax revenues and health care cost savings. CONCLUSIONS This stratified analysis improves on unitary approaches, illuminating distinct costs and benefits for stakeholders with political influence over SSB tax decisions.
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Affiliation(s)
- Parke Wilde
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
| | - Yue Huang
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
| | - Stephen Sy
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
| | - Shafika Abrahams-Gessel
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
| | - Thiago Veiga Jardim
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
| | - Robert Paarlberg
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
| | - Dariush Mozaffarian
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
| | - Renata Micha
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
| | - Thomas Gaziano
- Parke Wilde, Yue Huang, Dariush Mozaffarian, and Renata Micha are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Stephen Sy, Shafika Abrahams-Gessel, Thiago Veiga Jardim, and Thomas Gaziano are with the Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. T. Veiga Jardim and T. Gaziano are also with the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston. Robert Paarlberg is with the Harvard Kennedy School, Cambridge, MA
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Richardson TE, Yanada BA, Watters D, Stupart D, Lamichhane P, Bell C. What young Australians think about a tax on sugar‐sweetened beverages. Aust N Z J Public Health 2018; 43:63-67. [DOI: 10.1111/1753-6405.12858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/01/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
| | | | | | | | | | - Colin Bell
- School of MedicineDeakin University Victoria
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Buckton CH, Patterson C, Hyseni L, Katikireddi SV, Lloyd-Williams F, Elliott-Green A, Capewell S, Hilton S. The palatability of sugar-sweetened beverage taxation: A content analysis of newspaper coverage of the UK sugar debate. PLoS One 2018; 13:e0207576. [PMID: 30517133 PMCID: PMC6281206 DOI: 10.1371/journal.pone.0207576] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/02/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Excess sugar consumption, including sugar-sweetened beverages (SSBs), contributes to a variety of negative health outcomes, particularly for young people. The mass media play a powerful role in influencing public and policy-makers' perceptions of public health issues and their solutions. We analysed how sugar and SSB policy debates were presented in UK newspapers at a time of heightened awareness and following the announcement of the UK Government's soft drinks industry levy (SDIL), to inform future public health advocacy. METHODS & FINDINGS We carried out quantitative content analysis of articles discussing the issues of sugar and SSB consumption published in 11 national newspapers from April 2015 to November 2016. 684 newspaper articles were analysed using a structured coding frame. Coverage peaked in line with evidence publication, campaigner activities and policy events. Articles predominantly supportive of SSB taxation (23.5%) outnumbered those that were predominantly oppositional (14.2%). However, oppositional articles outnumbered supportive ones in the month of the announcement of the SDIL. Sugar and SSB consumption were presented as health risks, particularly affecting young people, with the actions of industry often identified as the cause of the public health problem. Responsibility for addressing sugar overconsumption was primarily assigned to government intervention. CONCLUSION Our results suggest that the policy landscape favouring fiscal solutions to curb sugar and SSB consumption has benefited from media coverage characterising the issue as an industry-driven problem. Media coverage may drive greater public acceptance of the SDIL and any future taxation of products containing sugar. However, future advocacy efforts should note the surge in opposition coinciding with the announcement of the SDIL, which echoes similar patterns of opposition observed in tobacco control debates.
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Affiliation(s)
- Christina H. Buckton
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Chris Patterson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, Liverpool, United Kingdom
| | - S. Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ffion Lloyd-Williams
- Department of Public Health & Policy, University of Liverpool, Liverpool, United Kingdom
| | - Alex Elliott-Green
- Department of Public Health & Policy, University of Liverpool, Liverpool, United Kingdom
| | - Simon Capewell
- Department of Public Health & Policy, University of Liverpool, Liverpool, United Kingdom
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Simpson N, Bartley A, Davies A, Perman S, Rodger AJ. Getting the balance right-tackling the obesogenic environment by reducing unhealthy options in a hospital shop without affecting profit. J Public Health (Oxf) 2018; 40:e545-e551. [PMID: 29635521 DOI: 10.1093/pubmed/fdy053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 03/05/2018] [Indexed: 01/20/2023] Open
Abstract
Background UK hospitals have been criticized for fuelling obesity by allowing contracts with food retailers selling high fat and high-sugar products on hospital premises. Methods We assessed the impact for a major retailer of increasing healthy food choices at their Royal Free London NHS Foundation Trust outlet. To assess the impact on sales, profit and acceptability to customers, a multi-component intervention based on behavioural insights theory was enacted over 2 months (November-December 2014) at the Royal Free site WHSmith. Sales data on all food and drink were assessed over three time periods: (i) 2 months immediately prior to, and (ii) immediately after the intervention, and (iii) the equivalent period 10 months later. Acceptability to customers was assessed via questionnaires, and profit assessed as a proxy for retailer satisfaction. Results Compared to the pre-intervention period, total sales increased immediately after the intervention, and again 10 months after the intervention. Sales of healthier options increased as a proportion of total sales following the intervention, sales of sweets and chocolates decreased, while the relative sales of other items remained similar. Conclusions We demonstrated that healthier alternatives could be provided in a hospital retail premises without negatively affecting total sales, retailer or customer satisfaction.
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Affiliation(s)
- Nandi Simpson
- Department of Public Health, Royal Free NHS London Foundation Trust, London, UK
| | - Angela Bartley
- Department of Public Health, Royal Free NHS London Foundation Trust, London, UK
| | - Alisha Davies
- Department of Public Health, Royal Free NHS London Foundation Trust, London, UK.,Research and Development, Public Health Wales, Cardiff, UK
| | - Sarah Perman
- Department of Public Health, Royal Free NHS London Foundation Trust, London, UK
| | - Alison J Rodger
- Department of Public Health, Royal Free NHS London Foundation Trust, London, UK.,Institute for Global Health, University College London, London, UK
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Food price trends in South Korea through time series analysis. Public Health 2018; 165:67-73. [PMID: 30384030 DOI: 10.1016/j.puhe.2018.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/14/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study analyzed the relative time trends of prices of healthy versus unhealthy foods in South Korea for the 20 years from 1995 to 2015. STUDY DESIGN Time series analysis was used. METHODS We analyzed price trends of selected food items in the food groups of grains, vegetables, meats, sweets, spices, fast foods, and non-alcoholic beverages. We obtained nominal prices from the monthly reports of the 2006 Consumer Price Survey for representative items in each food group. RESULTS The real price of processed meat increased by 1.2 percentage points less than the overall Consumer Price Index (CPI) increase, whereas beef prices increased by 2.4 percentage points more than the CPI increase. The price of soda was cheaper than that of other non-alcoholic beverages, whereas the real prices of milk showed statistically significantly larger yearly increases (by 1.4 percentage points, respectively) than that of the CPI. The yearly increases in the real prices of pizza, hamburgers, and fried chicken-three representative fast-food items that were mostly consumed by eating out or through home delivery-were statistically significantly less than those of the CPI (by 1.5, 1.4, and 0.3 percentage points, respectively). CONCLUSIONS Our results show that relatively healthy foods showed higher real price increases than the CPI increase, whereas the opposite occurred for unhealthy foods.
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Coupe N, Cotterill S, Peters S. Tailoring lifestyle interventions to low socio-economic populations: a qualitative study. BMC Public Health 2018; 18:967. [PMID: 30075716 PMCID: PMC6076398 DOI: 10.1186/s12889-018-5877-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background People living in deprived areas are more likely to be overweight or obese, have poorer health outcomes, and tend to benefit less from interventions than those from more affluent backgrounds. One approach to address such health inequalities is to tailor existing interventions to low socio-economic populations, yet there is limited evidence to inform their design. This study aims to identify how best to tailor lifestyle interventions to low socio-economic populations to improve outcomes. Methods Following direct observations of community-run weight loss groups, we interviewed 11 group facilitators and 14 service users from a health improvement service in a low socio-economic area in the North West of England. Audio-recorded interviews were transcribed verbatim and analysed thematically. Results We identified two overarching themes within the data. The first theme, managing diversity, included challenges faced in delivering a generic intervention to a diverse population in terms of knowledge, language and literacy skills, and cultural diversity. The second theme incorporated all issues relating to the environment, such as cost, access and availability of food and leisure facilities, and ‘life gets in the way’. Conclusions Tailoring interventions for this population is necessary, and more attention is needed to develop ways to ensure service providers and users engage with behaviour change techniques such as goal setting, rather than focusing on information provision alone. Interventions should also be mindful of cost, cultural diversity, and language and literacy barriers, as well as potential for disengaging this hard to reach population.
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Affiliation(s)
- Nia Coupe
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester, UK.
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester, UK
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Nakamura R, Mirelman AJ, Cuadrado C, Silva-Illanes N, Dunstan J, Suhrcke M. Evaluating the 2014 sugar-sweetened beverage tax in Chile: An observational study in urban areas. PLoS Med 2018; 15:e1002596. [PMID: 29969456 PMCID: PMC6029775 DOI: 10.1371/journal.pmed.1002596] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/29/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In October 2014, Chile implemented a tax modification on sugar-sweetened beverages (SSBs) called the Impuesto Adicional a las Bebidas Analcohólicas (IABA). The design of the tax was unique, increasing the tax on soft drinks above 6.25 grams of added sugar per 100 mL and decreasing the tax for those below this threshold. METHODS AND FINDINGS This study evaluates Chile's SSB tax, which was announced in March 2014 and implemented in October 2014. We used household-level grocery-purchasing data from 2011 to 2015 for 2,836 households living in cities representative of the urban population of Chile. We employed a fixed-effects econometric approach and estimated the before-after change in purchasing of SSBs controlling for seasonality, general time trend, temperature, and economic fluctuations as well as time-invariant household characteristics. Results showed significant changes in purchasing for the statistically preferred model: while there was a barely significant decrease in the volume of all soft drinks, there was a highly significant decrease in the monthly purchased volume of the higher-taxed, sugary soft drinks by 21.6%. The direction of this reduction was robust to different empirical modelling approaches, but the statistical significance and the magnitude of the changes varied considerably. The reduction in soft drink purchasing was most evident amongst higher socioeconomic groups and higher pretax purchasers of sugary soft drinks. There was no systematic, robust pattern in the estimates by household obesity status. After tax implementation, the purchase prices of soft drinks decreased for the items for which the tax rate was reduced, but they remained unchanged for sugary items, for which the tax was increased. However, the purchase prices increased for sugary soft drinks at the time of the policy announcement. The main limitations include a lack of a randomised design, limiting the extent of causal inference possible, and the focus on purchasing data rather than consumption or health outcomes. CONCLUSIONS The results of subgroup analyses suggest that the policy may have been partially effective, though not necessarily in ways that are likely to reduce socioeconomic inequalities in diet-related health. It remains unclear whether the policy has had a major, overall population-level impact. Additionally, because the present study examined purchasing of soft drinks for only 1 year, a longer-term evaluation-ideally including an assessment of consumption and health impacts-should be conducted in future research. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02926001.
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Affiliation(s)
- Ryota Nakamura
- Centre for Health Economics, University of York, York, United Kingdom
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | | | | | | | - Jocelyn Dunstan
- School of Public Health, University of Chile, Santiago, Chile
- ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, United Kingdom
- Luxembourg Institute for Socio-economic Research, Esch-sur-Alzette, Luxembourg
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Abstract
Currently, an unhealthy diet is the largest modifiable factor in ill health and death globally. One of the important contributors to unhealthy diets is the pervasiveness of unhealthy food and drink in our daily food environments. Although efforts to build nutrition skills and education across communities are critical, they will be insufficient without substantial changes to the food environments themselves. Here, I discuss how we can improve our food environments by implementing a comprehensive, multilevel and multisetting approach. This approach needs to encompass the various policy contexts for improving population nutrition, from policy set by national governments to that introduced by local community organizations and food retailers. Clinicians can help implement and set healthy food policies across all our health-care settings, even in the absence of government action. To support a comprehensive suite of effective policies, we need to systematically develop and disseminate the evidence for the feasibility, effectiveness and sustainability of workable policies and to understand their role in the development of a healthier food system.
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Affiliation(s)
- Anna Peeters
- Faculty of Health, Deakin University, Geelong, Victoria, Australia.
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Blake MR, Lancsar E, Peeters A, Backholer K. The effect of sugar-sweetened beverage price increases and educational messages on beverage purchasing behavior among adults. Appetite 2018; 126:156-162. [DOI: 10.1016/j.appet.2018.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
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Cornelsen L, Mytton OT, Adams J, Gasparrini A, Iskander D, Knai C, Petticrew M, Scott C, Smith R, Thompson C, White M, Cummins S. Change in non-alcoholic beverage sales following a 10-pence levy on sugar-sweetened beverages within a national chain of restaurants in the UK: interrupted time series analysis of a natural experiment. J Epidemiol Community Health 2018; 71:1107-1112. [PMID: 29038317 PMCID: PMC5847096 DOI: 10.1136/jech-2017-209947] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 11/05/2022]
Abstract
Background This study evaluates changes in sales of non-alcoholic beverages in Jamie’s Italian, a national chain of commercial restaurants in the UK, following the introduction of a £0.10 per-beverage levy on sugar-sweetened beverages (SSBs) and supporting activity including beverage menu redesign, new products and establishment of a children’s health fund from levy proceeds. Methods We used an interrupted time series design to quantify changes in sales of non-alcoholic beverages 12 weeks and 6 months after implementation of the levy, using itemised electronic point of sale data. Main outcomes were number of SSBs and other non-alcoholic beverages sold per customer. Linear regression and multilevel random effects models, adjusting for seasonality and clustering, were used to investigate changes in SSB sales across all restaurants (n=37) and by tertiles of baseline restaurant SSB sales per customer. Results Compared with the prelevy period, the number of SSBs sold per customer declined by 11.0% (−17.3% to −4.3%) at 12 weeks and 9.3% (−15.2% to −3.2%) at 6 months. For non-levied beverages, sales per customer of children’s fruit juice declined by 34.7% (−55.3% to −4.3%) at 12 weeks and 9.9% (−16.8% to −2.4%) at 6 months. At 6 months, sales per customer of fruit juice increased by 21.8% (14.0% to 30.2%) but sales of diet cola (−7.3%; −11.7% to −2.8%) and bottled waters (−6.5%; −11.0% to −1.7%) declined. Changes in sales were only observed in restaurants in the medium and high tertiles of baseline SSB sales per customer. Conclusions Introduction of a £0.10 levy on SSBs alongside complementary activities is associated with declines in SSB sales per customer in the short and medium term, particularly in restaurants with higher baseline sales of SSBs.
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Affiliation(s)
- Laura Cornelsen
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver T Mytton
- Centre for Diet & Activity Research & MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Jean Adams
- Centre for Diet & Activity Research & MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Antonio Gasparrini
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Dalia Iskander
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cecile Knai
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Petticrew
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Courtney Scott
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Smith
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Claire Thompson
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin White
- Centre for Diet & Activity Research & MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Steven Cummins
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Blake MR, Peeters A, Lancsar E, Boelsen-Robinson T, Corben K, Stevenson CE, Palermo C, Backholer K. Retailer-Led Sugar-Sweetened Beverage Price Increase Reduces Purchases in a Hospital Convenience Store in Melbourne, Australia: A Mixed Methods Evaluation. J Acad Nutr Diet 2018; 118:1027-1036.e8. [DOI: 10.1016/j.jand.2017.06.367] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/28/2017] [Indexed: 01/28/2023]
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Breeze P, Womack R, Pryce R, Brennan A, Goyder E. The impact of a local sugar sweetened beverage health promotion and price increase on sales in public leisure centre facilities. PLoS One 2018; 13:e0194637. [PMID: 29847553 PMCID: PMC5976158 DOI: 10.1371/journal.pone.0194637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/07/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We aimed to evaluate the impact of a local sugar sweetened beverages (SSB) health promotion and 20p price increase in leisure centre venues and estimate the impact on consumption. METHOD Monthly cold drinks sales data and attendance at leisure centres across the city of Sheffield were analysed over the period January 2015-July 2017. Interrupted time-series methods were employed to estimate changes in consumption per attendance of SSB and non-SSB cold drinks following the introduction of the SSB policy from August 2016 adjusting for seasonal variation and autocorrelation. SSB price elasticities were estimated with fixed effects log-log models by SSB product type (soda can, soda bottle, soda post mix, energy drinks, juice from concentrate). FINDINGS We estimated a 31% (95% CI 4%, 59%) reduction in units of SSB sold per attendance in the year since the policy was introduced. We did not observe substitution effects to fruit juice or water but found sales of other artificially sweetened non-SSB products increased by 27% (95% CI 6%, 47%) after the introduction of the tax. Price elasticity analysis identified that a 1% increase in price alongside health promotion leads to a 3.8% (95% CI 3.1% 4.4%) decrease in demand for SSB's. Price elasticity of demand was highest for child friendly and high caffeine energy drinks. INTERPRETATION Demand for SSB drinks at leisure centre venues is highly responsive to the policy, particularly for child-friendly and high caffeine energy drinks, compared with other SSB tax policy evaluations. The policy also increased purchases of carbonated non-SSB.
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Affiliation(s)
- Penny Breeze
- School for Health and Related Research, Sheffield, United Kingdom
| | | | - Robert Pryce
- School for Health and Related Research, Sheffield, United Kingdom
| | - Alan Brennan
- School for Health and Related Research, Sheffield, United Kingdom
| | - Elizabeth Goyder
- School for Health and Related Research, Sheffield, United Kingdom
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Vecino-Ortiz AI, Arroyo-Ariza D. A tax on sugar sweetened beverages in Colombia: Estimating the impact on overweight and obesity prevalence across socio economic levels. Soc Sci Med 2018; 209:111-116. [PMID: 29857325 DOI: 10.1016/j.socscimed.2018.05.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/19/2018] [Accepted: 05/25/2018] [Indexed: 12/27/2022]
Abstract
Colombia has a high prevalence of overweight (56%) and obesity (19%) among adults and is experiencing a growing trend in the prevalence of associated chronic conditions. Evidence suggests that sugar sweetened beverages (SSB) are associated to overweight/obesity, and that taxes on these beverages could reduce their associated health consequences. This paper assesses the potential effect of different levels of a SSB tax in Colombia on overweight and obesity prevalence. Using peer-reviewed local data on own-price elasticity of SSB, we applied a comparative risk assessment strategy to simulate the effect of the SSB tax on a nationally representative nutritional survey with 7140 adults in 2010 (ENSIN, 2010). Our results varied depending on the tax scenario, pass-through assumption and household socio economic strata (SES). We found that among individuals belonging to lower SES households, the SSB tax would reduce overweight and obesity between 1.5-4.9 and 1.1-2.4 percentage points (p < 0.05), respectively. Among individuals belonging to higher SES households, we found no statistically significant effects on obesity, and a reduction on overweight prevalence between 2.9 and 3.9 percentage points (p < 0.05). In the most conservative scenario (40% pass-through), a tax rate of at least 75 cents of Colombian peso (0.75 COP) per milliliter (24% of the average price) is needed to have statistically significant effects on both overweight and obesity prevalence among lower SES households. The results of this study suggest that a SSB tax could reduce the overweight and obesity prevalence in Colombia, especially among lower SES households. This study shows that SSB taxes have a particularly beneficial effect in the most vulnerable population. Additional social and individual benefits, or individual costs arising from the tax are not assessed in this research, implying that even larger health gains could be observed.
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Affiliation(s)
- Andres I Vecino-Ortiz
- Instituto de Salud Pública, Universidad Javeriana, Bogotá, Colombia; International Health Department - Johns Hopkins University, Baltimore, MD, United States; School of Medicine, Universidad de los Andes, Bogotá, Colombia.
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Asgari-Taee F, Zerafati-Shoae N, Dehghani M, Sadeghi M, Baradaran HR, Jazayeri S. Association of sugar sweetened beverages consumption with non-alcoholic fatty liver disease: a systematic review and meta-analysis. Eur J Nutr 2018; 58:1759-1769. [PMID: 29761318 DOI: 10.1007/s00394-018-1711-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The relationship between consumption of sugar sweetened beverages (SSB) and NAFLD has been reported in several epidemiological studies, but the results are inconsistent. The present systematic review and meta-analysis of observational studies was carried out to assess the relationship between sugar sweetened beverages consumption and NAFLD. METHODS Online databases were searched systematically through December, 2016 for studies investigating association between SSB consumption and NAFLD but limited to observational studies in human. Pooled odds ratio (OR) and 95% confidence intervals were calculated using Der-Simonian and Laird method while random effects meta-analysis was used, taking into account conceptual heterogeneity. Heterogeneity was assessed with the Cochran Q statistic and quantified with the I2 statistic. RESULTS Of the 1015 identified articles, 42 were reviewed in depth and six studies (four cross-sectional, one case-control, and one cohort) met the criteria for inclusion in our systematic review with 6326 participants and 1361 cases of NAFLD in both men and women. Finally, four cross-sectional studies were included in the meta-analysis. Higher intake of SSBs (highest compared to lowest categories) was significantly associated with NAFLD, with a 40% increased Odds of NAFLD after adjusting for important potential confounders (pooled odds ratio 1.40; 95% CI 1.07, 1.82). There was no evidence for significant heterogeneity across studies [P = 0.226 (Q statistics), I2 = 31.0%]. A significant positive association between SSB consumption and NAFLD was observed consistently in a sensitivity analysis [range of summary ORs 1.39-1.49]. There was no evidence of publication bias for the association between SSB and NAFLD. CONCLUSIONS This meta-analysis supports a positive significant association between higher consumption of SSB and NAFLD in both men and women. These findings strengthen the evidence that intake of SSBs should be limited to reduce fatty liver disease.
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Affiliation(s)
- Farzaneh Asgari-Taee
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Zerafati-Shoae
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Dehghani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Sadeghi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid R Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Jazayeri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: Microsimulation modelling using data from Liverpool, UK. PLoS Med 2018; 15:e1002573. [PMID: 29813056 PMCID: PMC5973555 DOI: 10.1371/journal.pmed.1002573] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Aiming to contribute to prevention of cardiovascular disease (CVD), the National Health Service (NHS) Health Check programme has been implemented across England since 2009. The programme involves cardiovascular risk stratification-at 5-year intervals-of all adults between the ages of 40 and 74 years, excluding any with preexisting vascular conditions (including CVD, diabetes mellitus, and hypertension, among others), and offers treatment to those at high risk. However, the cost-effectiveness and equity of population CVD screening is contested. This study aimed to determine whether the NHS Health Check programme is cost-effective and equitable in a city with high levels of deprivation and CVD. METHODS AND FINDINGS IMPACTNCD is a dynamic stochastic microsimulation policy model, calibrated to Liverpool demographics, risk factor exposure, and CVD epidemiology. Using local and national data, as well as drawing on health and social care disease costs and health-state utilities, we modelled 5 scenarios from 2017 to 2040: Scenario (A): continuing current implementation of NHS Health Check;Scenario (B): implementation 'targeted' toward areas in the most deprived quintile with increased coverage and uptake;Scenario (C): 'optimal' implementation assuming optimal coverage, uptake, treatment, and lifestyle change;Scenario (D): scenario A combined with structural population-wide interventions targeting unhealthy diet and smoking;Scenario (E): scenario B combined with the structural interventions as above. We compared all scenarios with a counterfactual of no-NHS Health Check. Compared with no-NHS Health Check, the model estimated cumulative incremental cost-effectiveness ratio (ICER) (discounted £/quality-adjusted life year [QALY]) to be 11,000 (95% uncertainty interval [UI] -270,000 to 320,000) for scenario A, 1,500 (-91,000 to 100,000) for scenario B, -2,400 (-6,500 to 5,700) for scenario C, -5,100 (-7,400 to -3,200) for scenario D, and -5,000 (-7,400 to -3,100) for scenario E. Overall, scenario A is unlikely to become cost-effective or equitable, and scenario B is likely to become cost-effective by 2040 and equitable by 2039. Scenario C is likely to become cost-effective by 2030 and cost-saving by 2040. Scenarios D and E are likely to be cost-saving by 2021 and 2023, respectively, and equitable by 2025. The main limitation of the analysis is that we explicitly modelled CVD and diabetes mellitus only. CONCLUSIONS According to our analysis of the situation in Liverpool, current NHS Health Check implementation appears neither equitable nor cost-effective. Optimal implementation is likely to be cost-saving but not equitable, while targeted implementation is likely to be both. Adding structural policies targeting cardiovascular risk factors could substantially improve equity and generate cost savings.
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83
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Evans C. How successful will the sugar levy be in improving diet and reducing inequalities in health? Perspect Public Health 2018; 138:85-86. [PMID: 29465014 DOI: 10.1177/1757913917750966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The nutritional content of supermarket beverages: a cross-sectional analysis of New Zealand, Australia, Canada and the UK. Public Health Nutr 2018; 21:2507-2516. [PMID: 29409560 DOI: 10.1017/s1368980017004128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the nutritional content, serving size and taxation potential of supermarket beverages from four different Western countries. DESIGN Cross-sectional analysis. Multivariate regression analysis and χ 2 comparisons were used to detect differences between countries. SETTING Supermarkets in New Zealand (NZ), Australia, Canada and the UK. SUBJECTS Supermarket beverages in the following categories: fruit juices, fruit-based drinks, carbonated soda, waters and sports/energy drinks. RESULTS A total of 4157 products were analysed, including 749 from NZ, 1738 from Australia, 740 from Canada and 930 from the UK. NZ had the highest percentage of beverages with sugar added to them (52 %), while the UK had the lowest (39 %, P<0.001). CONCLUSIONS There is substantial difference between countries in the mean energy, serving size and proportion of products eligible for fiscal sugar taxation. Current self-regulatory approaches used in these countries may not be effective to reduce the availability, marketing and consumption of sugar-sweetened beverages and subsequent intake of free sugars.
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Stacey N, Summan A, Tugendhaft A, Laxminarayan R, Hofman K. Simulating the impact of excise taxation for disease prevention in low-income and middle-income countries: an application to South Africa. BMJ Glob Health 2018. [PMID: 29515917 PMCID: PMC5838397 DOI: 10.1136/bmjgh-2017-000568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Excise taxes are policy tools that have been applied internationally with some success to reduce consumption of products adversely impacting population health including tobacco, alcohol and increasingly junk foods and sugary beverages. As in other low-income and middle-income countries, South Africa faces a growing burden of lifestyle diseases; accordingly we simulate the impact of multiple excise tax interventions in this setting. Methods We construct a mathematical model to simulate the health and revenue effects of increased excise taxes, which is adaptable to a variety of settings given its limited data requirements. Applying the model to South Africa, we simulate the impact of increased tax rates on tobacco and beer and of the introduction of a tax on sugar-sweetened beverages (SSB). Drawing on surveys of product usage and risk factor prevalence, the model uses a potential impact fraction to simulate the health effects of tax interventions. Results Adopting an excise rate of 60% on tobacco would result in a gain of 858 923 life-years (95% uncertainty interval (UI) 480 188 to 1 310 329), while adopting an excise rate of 25% on beer would result in a gain of 568 063 life-years (95% UI 412 110 to 775 560) and the adoption of a 20% tax on SSBs would result in a gain of 688 719 life-years (95% UI 321 788 to 1 079 653). Conclusion More aggressive excise tax policies on tobacco, beer and SSBs in South Africa could result in meaningful improvements in population health and raised revenue.
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Affiliation(s)
- Nicholas Stacey
- Priority Cost Effective Lessons for Systems Strengthening, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amit Summan
- Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA
| | - Aviva Tugendhaft
- Priority Cost Effective Lessons for Systems Strengthening, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ramanan Laxminarayan
- Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA
| | - Karen Hofman
- Priority Cost Effective Lessons for Systems Strengthening, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Goryakin Y, Monsivais P, Suhrcke M. Soft drink prices, sales, body mass index and diabetes: Evidence from a panel of low-, middle- and high-income countries. FOOD POLICY 2017; 73:88-94. [PMID: 29276333 PMCID: PMC5727680 DOI: 10.1016/j.foodpol.2017.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 09/16/2017] [Accepted: 09/23/2017] [Indexed: 06/02/2023]
Abstract
We take advantage of four different cross-country datasets containing data on 78 countries for the period 1999-2014, in order to assess the relationship of carbonated soft drinks' sales, as well as their prices, with body mass index (BMI), overweight, obesity and diabetes. Using an ecological study design and multivariate regression longitudinal estimation approaches, we find that carbonated soft drink sales were significantly positively related to BMI, overweight and obesity - but only in the low and lower-middle income countries. This finding was robust to a number of sensitivity and falsification checks. In this sub-sample, an increase in per capita soft drink sales by 1 litre per year was related to an increase of BMI by about 0.009 kg/m2 (p < 0.1).. This is a small effect, implying that halving annual consumption per capita in this group of countries would result in a drop of BMI by only about 0.03 kg/m2. Although soft drink prices were negatively related to weight-related outcomes in the sample of higher middle income and high income countries, this finding was not robust to falsification checks. The results thus suggest that sales restrictions to steer consumers away from soft drinks could indeed have a beneficial health effects in poorer countries, although the effect magnitude appears to be very small. However, given potential limitations of using ecological research design, results from individual level studies would be required to further ascertain the role of soft drink sales and prices in obesity and diabetes.
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Affiliation(s)
- Yevgeniy Goryakin
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Pablo Monsivais
- UKCRC Centre for Diet and Activity Research, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Nutrition and Exercise Physiology, Elson S Floyd College of Medicine, Washington State University, Spokane, WA 99210-1495, USA
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York YO10 5DD, UK
- Luxembourg Institute for Socio-Economic Research, L-4366 Esch-sur-Alzette/Belval, Luxembourg
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Abstract
The use of taxes to promote healthy nutritional behaviour has gained ground in the past decade. The present paper reviews existing applications of fiscal instruments in nutrition policy and derives some perspectives and recommendations from the experiences gained with these instruments. Many countries in different parts of the world have experiences with the taxation of sugar-sweetened beverages, in some cases in combination with taxes on unhealthy food commodities such as confectionery or high-fat foods. These tax schemes have many similarities, but also differ in their definitions of tax objects and in the applied tax rates. Denmark has been the only country in the world to operate a tax on saturated fat content in foods, from 2011 to 2012. Most of the existing food tax schemes have been introduced from fiscal motivations, with health promotion as a secondary objective, but a few have been introduced with health promotion as the primary objective. The diversity in experiences from existing tax schemes can provide valuable insights for future use of fiscal instruments to promote healthy nutrition, in terms of designing effective and efficient tax or subsidy instruments, and in terms of smooth and politically viable implementation of the instruments.
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Bascuñán J, Cuadrado C. Effectiveness of sugar-sweetened beverages taxes to reduce obesity: evidence brief for policy. Medwave 2017; 17:e7054. [DOI: 10.5867/medwave.2017.08.7054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/02/2017] [Indexed: 11/27/2022] Open
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Francis J, Martin K, Costa B, Christian H, Kaur S, Harray A, Barblett A, Oddy WH, Ambrosini G, Allen K, Trapp G. Informing Intervention Strategies to Reduce Energy Drink Consumption in Young People: Findings From Qualitative Research. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:724-733.e1. [PMID: 28987203 DOI: 10.1016/j.jneb.2017.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine young people's knowledge of energy drinks (EDs), factors influencing ED consumption, and intervention strategies to decrease ED consumption in young people. DESIGN Eight group interviews with young people (aged 12-25 years). SETTING Community groups and secondary schools in Perth, Western Australia. PARTICIPANTS Forty-one young people, 41% of whom were male and 73% of whom consumed EDs. PHENOMENON OF INTEREST Factors influencing ED consumption and intervention strategies informed by young people to reduce ED consumption. ANALYSIS Two researchers conducted a qualitative content analysis on the data using NVivo software. RESULTS Facilitators of ED consumption included enhanced energy, pleasant taste, low cost, peer pressure, easy availability, and ED promotions. Barriers included negative health effects, unpleasant taste, high cost, and parents' disapproval. Strategies to reduce ED consumption included ED restrictions, changing ED packaging, increasing ED prices, reducing visibility in retail outlets, and research and education. CONCLUSION AND IMPLICATIONS Because many countries allow the sale of EDs to people aged <18 years, identifying ways to minimize potential harm from EDs is critical. This study provided unique insights into intervention strategies suggested by young people to reduce ED consumption. In addition to more research and education, these strategies included policy changes targeting ED sales, packaging, price, and visibility. Future research might examine the feasibility of implementing such interventions.
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Affiliation(s)
| | - Karen Martin
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia
| | - Beth Costa
- Institute for Safety, Compensation, and Recovery Research, Monash University, Geelong Victoria, Australia
| | - Hayley Christian
- Telethon Kids Institute, West Perth, Western Australia; School of Population and Global Health, University of Western Australia, Crawley, Western Australia
| | - Simmi Kaur
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia
| | - Amelia Harray
- National Heart Foundation of Australia, Subiaco, Western Australia
| | - Ann Barblett
- Health Department of Western Australia, Fremantle, Western Australia
| | - Wendy Hazel Oddy
- Telethon Kids Institute, West Perth, Western Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Gina Ambrosini
- Telethon Kids Institute, West Perth, Western Australia; School of Population and Global Health, University of Western Australia, Crawley, Western Australia
| | - Karina Allen
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College, London, United Kingdom; Maudsley Hospital, London, United Kingdom; School of Psychology, University of Western Australia, Crawley, Western Australia
| | - Gina Trapp
- Telethon Kids Institute, West Perth, Western Australia; School of Population and Global Health, University of Western Australia, Crawley, Western Australia.
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Breeze PR, Thomas C, Squires H, Brennan A, Greaves C, Diggle P, Brunner E, Tabak A, Preston L, Chilcott J. Cost-effectiveness of population-based, community, workplace and individual policies for diabetes prevention in the UK. Diabet Med 2017; 34:1136-1144. [PMID: 28294392 PMCID: PMC5573930 DOI: 10.1111/dme.13349] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 12/28/2022]
Abstract
AIM To analyse the cost-effectiveness of different interventions for Type 2 diabetes prevention within a common framework. METHODS A micro-simulation model was developed to evaluate the cost-effectiveness of a range of diabetes prevention interventions including: (1) soft drinks taxation; (2) retail policy in socially deprived areas; (3) workplace intervention; (4) community-based intervention; and (5) screening and intensive lifestyle intervention in individuals with high diabetes risk. Within the model, individuals follow metabolic trajectories (for BMI, cholesterol, systolic blood pressure and glycaemia); individuals may develop diabetes, and some may exhibit complications of diabetes and related disorders, including cardiovascular disease, and eventually die. Lifetime healthcare costs, employment costs and quality-adjusted life-years are collected for each person. RESULTS All interventions generate more life-years and lifetime quality-adjusted life-years and reduce healthcare spending compared with doing nothing. Screening and intensive lifestyle intervention generates greatest lifetime net benefit (£37) but is costly to implement. In comparison, soft drinks taxation or retail policy generate lower net benefit (£11 and £11) but are cost-saving in a shorter time period, preferentially benefit individuals from deprived backgrounds and reduce employer costs. CONCLUSION The model enables a wide range of diabetes prevention interventions to be evaluated according to cost-effectiveness, employment and equity impacts over the short and long term, allowing decision-makers to prioritize policies that maximize the expected benefits, as well as fulfilling other policy targets, such as addressing social inequalities.
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Affiliation(s)
- P. R. Breeze
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - C. Thomas
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - H. Squires
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - A. Brennan
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - C. Greaves
- University of Exeter Medical SchoolUniversity of ExeterExeter
| | - P. Diggle
- Medical SchoolLancaster UniversityLancaster
- Institute of Infection and Global HealthUniversity of LiverpoolLiverpool
| | - E. Brunner
- Epidemiology and Public HealthUniversity College LondonLondonUK
| | - A. Tabak
- Epidemiology and Public HealthUniversity College LondonLondonUK
- First Department of MedicineSemmelweis University Faculty of MedicineBudapestHungary
| | - L. Preston
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - J. Chilcott
- School of Health and Related ResearchUniversity of SheffieldSheffield
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Caro JC, Smith-Taillie L, Ng SW, Popkin B. Designing a food tax to impact food-related non-communicable diseases: the case of Chile. FOOD POLICY 2017; 71:86-100. [PMID: 29375180 PMCID: PMC5783649 DOI: 10.1016/j.foodpol.2017.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The global shift towards diets high in sugar-sweetened beverages (SSBs) and energy dense ultra-processed foods is linked to higher prevalence of obesity, diabetes and most other noncommunicable diseases (NCDs), causing significant health costs. Chile has the highest SSB consumption in the world, very high junk food intake and very rapid increases in these poor components of the diet plus obesity prevalence. This study's purpose is to compare the effect of different tax schemes for SSBs and ultra-processed foods on nutrient availability, utilizing price-elasticities, which are estimated from a Quadratic Almost Ideal Demand System model, using the 2011-2012 Income and Expenditure survey. We take into account the high proportion of households not purchasing various food and beverage groups (censored nature of data). The food groups considered were: sweets and desserts; salty snacks and chips; meat products and fats; fruits, vegetables and seafood; cereals and cereal products; SSB ready-to-drink; SSB from concentrate; plain water, coffee and tea; and milk, which together represent 90% of food expenditures. The simulated taxes were: (1) 40% price tax on SSBs(22% above the current tax level); (2) a 5 cents per gram of sugar tax on products with added sugar; and (3) 30% price tax on all foods(27% above current tax levels) and beverages (12% above the current tax level) exceeding thresholds on sodium, saturated fat, and added sugar and for which marketing is restricted (based on a Chilean law, effective June 16 2016). Unhealthy foods are price-elastic (-1.99 for salty snacks and chips, -1.06 for SSBs ready-to-drink, and -1.27 for SSBs from concentrate), meaning that the change in consumption is proportionally larger with respect to a change in price. Results are robust to different model specification, and consistent among different socioeconomic sub-populations. Overall, the tax on marketing controlled foods and beverages is associated with the largest reduction in household purchases of sodium, added sugar, saturated fat and calorie purchases. Chile is unique in currently having instituted a small current SSB tax as well as marketing controls and front-of-package labeling of unhealthy foods and beverages. The design of a larger, more comprehensive tax to enhance the overall effect of these policies on healthier diets is a next critical step. This study shows that a large tax on the same foods and beverages already delineated as unhealthy by the marketing controls and front-of-pack labeling should prove to be more effective for promoting a healthier diet.
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Affiliation(s)
- Juan Carlos Caro
- National Institute of Nutrition and Food Technology (INTA),University of Chile, Santiago
| | - Lindsey Smith-Taillie
- Carolina Population Center and Dept of Nutrition, School of Public Health, University of North Carolina
| | - Shu Wen Ng
- Carolina Population Center and Dept of Nutrition, School of Public Health, University of North Carolina
| | - Barry Popkin
- Carolina Population Center and Dept of Nutrition, School of Public Health, University of North Carolina
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Wright A, Smith KE, Hellowell M. Policy lessons from health taxes: a systematic review of empirical studies. BMC Public Health 2017; 17:583. [PMID: 28629470 PMCID: PMC5477308 DOI: 10.1186/s12889-017-4497-z] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Taxes on alcohol and tobacco have long been an important means of raising revenues for public spending in many countries but there is increasing interest in using taxes on these, and other unhealthy products, to achieve public health goals. We present a systematic review of the research on health taxes, and aim to generate insights into how such taxes can: (i) reduce consumption of targeted products and related harms; (ii) generate revenues for health objectives and distribute the tax burden across income groups in an efficient and equitable manner; and (iii) be made politically sustainable. METHODS Six scientific and four grey-literature databases were searched for empirical studies of 'health taxes' - defined as those intended to increase the costs of manufacturing, distributing, retailing and/or consuming health-damaging products. Since reviews already exist of the evidence relating to traditional alcohol and tobacco excise taxes, we focus on other taxes such as taxes on retailers and manufacturers of unhealthy products, and consumer taxes targeting unhealthy foods, such as sugar-sweetened beverages. RESULTS Ninety-one peer-reviewed and 11 grey-literature studies met our inclusion criteria. The review highlights a recent, rapid rise in research in this area, most of which focuses on high-income countries and on taxes on food products or nutrients. Findings demonstrate that high tax rates on sugar-sweetened beverages are likely to have a positive impact on health behaviours and outcomes, and, while taxes on products reduce demand, they add to fiscal revenues. Common concerns about health taxes are also discussed. CONCLUSIONS If the primary policy goal of a health tax is to reduce consumption of unhealthy products, then evidence supports the implementation of taxes that increase the price of products by 20% or more. However, where taxes are effective in changing health behaviours, the predictability of the revenue stream is reduced. Hence, policy actors need to be clear about the primary goal of any health tax and frame the tax accordingly - not doing so leaves taxes vulnerable to hostile lobbying. Conversely, earmarking health taxes for health spending tends to increase public support so long as policymakers follow through on specified spending commitments. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42016048603.
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Affiliation(s)
- Alexandra Wright
- Global Public Health Unit, Social Policy, School of Social & Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD UK
| | - Katherine E. Smith
- Global Public Health Unit, Social Policy, School of Social & Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD UK
| | - Mark Hellowell
- Global Public Health Unit, Social Policy, School of Social & Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD UK
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Barrientos-Gutierrez T, Zepeda-Tello R, Rodrigues ER, Colchero-Aragonés A, Rojas-Martínez R, Lazcano-Ponce E, Hernández-Ávila M, Rivera-Dommarco J, Meza R. Expected population weight and diabetes impact of the 1-peso-per-litre tax to sugar sweetened beverages in Mexico. PLoS One 2017; 12:e0176336. [PMID: 28520716 PMCID: PMC5435164 DOI: 10.1371/journal.pone.0176336] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/10/2017] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION What effect on body mass index, obesity and diabetes can we expect from the 1-peso-per-litre tax to sugar sweetened beverages in Mexico? METHODS Using recently published estimates of the reductions in beverage purchases due to the tax, we modelled its expected long-term impacts on body mass index (BMI), obesity and diabetes. Microsimulations based on a nationally representative dataset were used to estimate the impact of the tax on BMI and obesity. A Markov population model, built upon an age-period-cohort model of diabetes incidence, was used to estimate the impact on diagnosed diabetes in Mexico. To analyse the potential of tax increases we also modelled a 2-peso-per-litre tax scenario. STUDY ANSWER AND LIMITATIONS Ten years after the implementation of the tax, we expect an average reduction of 0.15 kg/m2 per person, which translates into a 2.54% reduction in obesity prevalence. People in the lowest level of socioeconomic status and those between 20 and 35 years of age showed the largest reductions in BMI and overweight and obesity prevalence. Simulations show that by 2030, under the current implementation of 1-peso-per-litre, the tax would prevent 86 to 134 thousand cases of diabetes. Overall, the 2-peso-per-litre scenario is expected to produce twice as much of a reduction. These estimates assume the tax effect on consumption remains stable over time. Sensitivity analyses were conducted to assess the robustness of findings; similar results were obtained with various parameter assumptions and alternative modelling approaches. WHAT THIS STUDY ADDS The sugar-sweetened beverages tax in Mexico is expected to produce sizable and sustained reductions in obesity and diabetes. Increasing the tax could produce larger benefits. While encouraging, estimates will need to be updated once data on direct changes in consumption becomes available.
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Affiliation(s)
| | - Rodrigo Zepeda-Tello
- Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Eliane R. Rodrigues
- Instituto de Matemáticas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Rosalba Rojas-Martínez
- Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Eduardo Lazcano-Ponce
- Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Juan Rivera-Dommarco
- Centre for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States of America
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94
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Abstract
Domestic US sugar production has been protected by government policy for the past 82 years, resulting in elevated domestic prices and an estimated annual (2013) $1.4 billion dollar “tax” on consumers. These elevated prices and the simultaneous federal support for domestic corn production have ensured a strong market for high-fructose corn syrup. Americans have dramatically increased their consumption of caloric sweeteners during the same period. Consumption of “empty” calories (ie, foods with low-nutrient/high-caloric density)—sugar and high-fructose corn syrup being the primary sources—is considered by most public health experts to be a key contributing factor to the rise in obesity. There have been substantial efforts to tax sugar-sweetened beverages (SSBs) to both reduce consumption and provide a source of funds for nutrition education, thereby emulating the tobacco tax model. Volume-based SSB taxes levy the tax rate per ounce of liquid, where some are only imposed on beverages with added sugar content exceeding a set threshold. Nonetheless, volume-based taxes have significant limitations in encouraging consumers to reduce their caloric intake due to a lack of transparency at the point of purchase. Thus, it is hypothesized that point-of-purchase, nutrient-specific excise taxes on SSBs would be more effective at reducing sugar consumption. However, all SSB taxes are limited by the possibility that consumers may compensate their decreased intake from SSBs with other high-calorie junk foods. Furthermore, there are no existing studies to provide evidence on how SSB taxes will impact obesity rates in the long term. The paradox of sugar prices is that Americans have paid higher prices for sugar to protect domestic production for more than 80 years, and now, Americans are being asked to pay even more to promote public health. The effective use of sugar taxes should be considered based on their merits in reducing sugar consumption and making available a new source of funds to support nutrition education, not on lobbying efforts by the food industry or sugar and corn producers.
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95
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Hoffmann K, De Gelder R, Hu Y, Bopp M, Vitrai J, Lahelma E, Menvielle G, Santana P, Regidor E, Ekholm O, Mackenbach JP, van Lenthe FJ. Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010. Int J Behav Nutr Phys Act 2017; 14:63. [PMID: 28482914 PMCID: PMC5421333 DOI: 10.1186/s12966-017-0517-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 04/22/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010. METHODS Nationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30-64 years. RESULTS A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women. CONCLUSION The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.
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Affiliation(s)
- Kristina Hoffmann
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rianne De Gelder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Yannan Hu
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Jozsef Vitrai
- National Institute for Health Development, Budapest, Hungary
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Gwenn Menvielle
- Sorbonne Universités, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Paula Santana
- Departamento de Geografia, Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
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96
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Nomaguchi T, Cunich M, Zapata-Diomedi B, Veerman JL. The impact on productivity of a hypothetical tax on sugar-sweetened beverages. Health Policy 2017; 121:715-725. [PMID: 28420538 DOI: 10.1016/j.healthpol.2017.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To quantify the potential impact of an additional 20% tax on sugar-sweetened beverages (SSBs) on productivity in Australia. METHODS We used a multi-state lifetable Markov model to examine the potential impact of an additional 20% tax on SSBs on total lifetime productivity in the paid and unpaid sectors of the economy. The study population consisted of Australians aged 20 years or older in 2010, whose health and other relevant outcomes were modelled over their remaining lifetime. RESULTS The SSBs tax was estimated to reduce the number of people with obesity by 1.96% of the entire population (437,000 fewer persons with obesity), and reduce the number of employees with obesity by 317,000 persons. These effects translated into productivity gains in the paid sector of AU$751 million for the working-age population (95% confidence interval: AU$565 million to AU$954 million), using the human capital approach. In the unpaid sector, the potential productivity gains amounted to AU$1172 million (AU$929 million to AU$1435 million) using the replacement cost method. These productivity benefits are in addition to the health benefits of 35,000 life years gained and a reduction in healthcare costs of AU$425 million. CONCLUSIONS An additional 20% tax on SSBs not only improves health outcomes and reduces healthcare costs, but provides productivity gains in both the paid and unpaid sectors of the economy.
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Affiliation(s)
- Takeshi Nomaguchi
- Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Queensland 4072, Australia.
| | - Michelle Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales 2006, Australia
| | - Belen Zapata-Diomedi
- School of Public Health, The University of Queensland, Brisbane, Queensland 4006, Australia
| | - J Lennert Veerman
- Cancer Council NSW, 2011, Australia; School of Public Health, The University of Queensland, Brisbane, Queensland 4006, Australia
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97
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Brand-Miller JC, Barclay AW. Declining consumption of added sugars and sugar-sweetened beverages in Australia: a challenge for obesity prevention. Am J Clin Nutr 2017; 105:854-863. [PMID: 28275129 DOI: 10.3945/ajcn.116.145318] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/19/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Reduced intakes of added sugars and sugar-sweetened beverages (SSBs) have been the main focus of efforts to stall obesity. Although obesity has risen steeply in Australia, some evidence suggests that added-sugars and SSB intakes have declined over the same time frame.Objective: We investigated recent trends in the availability of sugars and sweeteners and changes in intakes of total sugars, added sugars, and SSBs in Australia by using multiple, independent data sources.Design: The study was designed to compare relevant data published by the Food and Agriculture Organization of the United Nations [FAO Statistics Division Database (FAOSTAT)], the Australian government, academia, and the food industry.Results: With the use of the FAOSTAT food balance sheets for Australia, the per capita availability of added or refined sugars and sweeteners was shown to have fallen 16% from 152 g/d in 1980 to 127 g/d in 2011 (P-trend = 0.001). In national dietary surveys in 1995 and 2011-2012, added-sugars intake declined markedly in adult men (from 72 to 59 g/d; -18%) but not in women (44-42 g/d; NS). As a proportion of total energy, added-sugars intake fell 10% in adult men but nonsignificantly in adult women. Between 1995 and 2011-2012, the proportion of energy from SSBs (including 100% juice) declined 10% in adult men and 20% in women. More marked changes were observed in children aged 2-18 y. Data from national grocery sales indicated that per capita added-sugars intakes derived from carbonated soft drinks fell 26% between 1997 and 2011 (from 23 to 17 g/d) with similar trends for noncarbonated beverages.Conclusions: In Australia, 4 independent data sets confirmed shorter- and longer-term declines in the availability and intake of added sugars, including those contributed by SSBs. The findings challenge the widespread belief that energy from added sugars or sugars in solution are uniquely linked to the prevalence of obesity.
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Affiliation(s)
- Jennie C Brand-Miller
- Charles Perkins Center and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia; and
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98
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Feldman AL, Griffin SJ, Ahern AL, Long GH, Weinehall L, Fhärm E, Norberg M, Wennberg P. Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants. BMC Public Health 2017; 17:170. [PMID: 28166764 PMCID: PMC5294882 DOI: 10.1186/s12889-017-4081-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/27/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Weight loss in individuals at high risk of diabetes is an effective prevention method and a major component of the currently prevailing diabetes prevention strategies. The aim of the present study was to investigate the public health potential for diabetes prevention of weight maintenance or moderate weight loss on a population level in an observational cohort with repeated measurements of weight and diabetes status. METHODS Height, weight and diabetes status were objectively measured at baseline and 10 year follow-up in a population-based cohort of 33,184 participants aged 30-60 years between 1990 and 2013 in Västerbotten County, Sweden. The association between risk of incident diabetes and change in BMI or relative weight was modelled using multivariate logistic regression. Population attributable fractions (PAF) were used to assess population impact of shift in weight. RESULTS Mean (SD) BMI at baseline was 25.0 (3.6) kg/m2. Increase in relative weight between baseline and follow-up was linearly associated with incident diabetes risk, odds ratio (OR) 1.05 (95% confidence interval (CI) 1.04-1.06) per 1% change in weight. Compared to weight maintenance (±1.0 kg/m2), weight gain of > +1.0 kg/m2 was associated with an increased risk of incident diabetes, OR 1.52 (95% CI 1.32, 1.74), representing a PAF of 21.9% (95% CI 15.8, 27.6%). For moderate weight loss (-1.0 to -2.0 kg/m2) the OR was 0.72 (95% CI 0.52, 0.99). CONCLUSIONS Weight maintenance in adulthood is strongly associated with reduced incident diabetes risk and there is considerable potential for diabetes prevention in promoting this as a whole population strategy.
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Affiliation(s)
- Adina L Feldman
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Grainne H Long
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Lars Weinehall
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Eva Fhärm
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
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99
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Cobiac LJ, Tam K, Veerman L, Blakely T. Taxes and Subsidies for Improving Diet and Population Health in Australia: A Cost-Effectiveness Modelling Study. PLoS Med 2017; 14:e1002232. [PMID: 28196089 PMCID: PMC5308803 DOI: 10.1371/journal.pmed.1002232] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An increasing number of countries are implementing taxes on unhealthy foods and drinks to address the growing burden of dietary-related disease, but the cost-effectiveness of combining taxes on unhealthy foods and subsidies on healthy foods is not well understood. METHODS AND FINDINGS Using a population model of dietary-related diseases and health care costs and food price elasticities, we simulated the effect of taxes on saturated fat, salt, sugar, and sugar-sweetened beverages and a subsidy on fruits and vegetables, over the lifetime of the Australian population. The sizes of the taxes and subsidy were set such that, when combined as a package, there would be a negligible effect on average weekly expenditure on food (<1% change). We evaluated the cost-effectiveness of the interventions individually, then determined the optimal combination based on maximising net monetary benefit at a threshold of AU$50,000 per disability-adjusted life year (DALY). The simulations suggested that the combination of taxes and subsidy might avert as many as 470,000 DALYs (95% uncertainty interval [UI]: 420,000 to 510,000) in the Australian population of 22 million, with a net cost-saving of AU$3.4 billion (95% UI: AU$2.4 billion to AU$4.6 billion; US$2.3 billion) to the health sector. Of the taxes evaluated, the sugar tax produced the biggest estimates of health gain (270,000 [95% UI: 250,000 to 290,000] DALYs averted), followed by the salt tax (130,000 [95% UI: 120,000 to 140,000] DALYs), the saturated fat tax (97,000 [95% UI: 77,000 to 120,000] DALYs), and the sugar-sweetened beverage tax (12,000 [95% UI: 2,100 to 21,000] DALYs). The fruit and vegetable subsidy (-13,000 [95% UI: -44,000 to 18,000] DALYs) was a cost-effective addition to the package of taxes. However, it did not necessarily lead to a net health benefit for the population when modelled as an intervention on its own, because of the possible adverse cross-price elasticity effects on consumption of other foods (e.g., foods high in saturated fat and salt). The study suggests that taxes and subsidies on foods and beverages can potentially be combined to achieve substantial improvements in population health and cost-savings to the health sector. However, the magnitude of health benefits is sensitive to measures of price elasticity, and further work is needed to incorporate potential benefits or harms associated with changes in other foods and nutrients that are not currently modelled, such as red and processed meats and fibre. CONCLUSIONS With potentially large health benefits for the Australian population and large benefits in reducing health sector spending on the treatment of non-communicable diseases, the formulation of a tax and subsidy package should be given a more prominent role in Australia's public health nutrition strategy.
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Affiliation(s)
- Linda J. Cobiac
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - King Tam
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Lennert Veerman
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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100
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Schwendicke F, Stolpe M. Taxing sugar-sweetened beverages: impact on overweight and obesity in Germany. BMC Public Health 2017; 17:88. [PMID: 28095809 PMCID: PMC5240244 DOI: 10.1186/s12889-016-3938-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/13/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Consumption of sugar-sweetened beverages (SSBs) increases the risk of overweight and obesity. Taxing SSBs could decrease daily energy consumption and body weight. This model-based study evaluated the impact of a 20% SSB-sales tax on overweight and obesity in the context of Germany. METHODS The population aged 15-79 years was modelled. Taxation was assumed to affect energy consumption via demand elasticities, which affected weight and BMI. Model-based analysis was performed to estimate the tax impact on BMI in different age, gender and income groups. RESULTS Implementing a 20% SSB tax reduced energy consumption mainly in younger age groups, males, and those with low income. Taxation decreased the mean BMI in younger groups, with the largest decrease in those aged 20-29 years, while effects in groups 60 years or above were minimal. In absolute terms, taxation was estimated to avoid 1,028,000 (-3% relative reduction) overweight individuals and 479,000 obese individuals (-4%). Overweight decreased the most in males aged 20-29 years (408,000 fewer cases /-22%), the same applied for obesity (204,000/-22%). CONCLUSIONS An SSB tax could have significant impact on overweight and obesity, which could translate into substantial reductions of morbidity and mortality.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Michael Stolpe
- Kiel Institute for the World Economy, Kiellinie 66, 24105 Kiel, Germany
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