1
|
Luick M, Bandy LK, Harrington R, Vijayan J, Adams J, Cummins S, Rayner M, Rogers N, Rutter H, Smith R, White M, Scarborough P. The impact of the UK soft drink industry levy on the soft drink marketplace, 2017-2020: An interrupted time series analysis with comparator series. PLoS One 2024; 19:e0301890. [PMID: 38843248 PMCID: PMC11156274 DOI: 10.1371/journal.pone.0301890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/25/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND In April 2018, the UK government implemented a levy on soft drinks importers and manufacturers, tiered according to the amount of sugar in drinks. The stated aim was to encourage manufacturers to reduce sugar and portion sizes. Previous evidence suggests that the policy has been successful in reducing sugar in drinks in the short-term since implementation, but their sustained effects have not been explored. This study aimed to assess the impact of the soft drink industry levy (SDIL) on sugar levels, price, portion size and use of non-sugar sweeteners in the medium-term. METHODS AND FINDINGS Product data from 30 November 2017 to 14 March 2020 from one major UK retail supermarket were analysed (112,452 observations, 126 weekly time points). We used interrupted time series analysis, to assess the impact of the soft-drink industry levy (SDIL) on levy-eligible soft drinks, with exempt drinks (i.e. 100% fruit juices, milks, flavoured milks) acting as a comparator series. At the point of implementation of the SDIL (April 2018) there was a step change in the proportion of eligible drinks with sugar content below the SDIL levy threshold (5g per 100ml) (+0.08, 95%CI: +0.04, +0.12), with a similar sized decrease in the proportion in the highest levy category (> = 8g sugar per 100ml) (-0.06, 95%CI: -0.10, -0.03). Between April 2018 and March 2020, the proportion of eligible drinks below the SDIL levy threshold continued to gradually increase (p = 0.003), while those in the highest levy category decreased (p = 0.007). There was a step change in price of eligible drinks in the higher levy category at the point of implementation of +£0.049 (95%CI: +£0.034, +£0.065) per 100mL (for comparison, the levy is set at £0.024 per 100mL for this group). Trends in price for the high levy category were not altered by the SDIL. In the no levy category, there was a step change in price at the implementation (+£0.012 per 100mL, 95%CI: +£0.008, +£0.023), followed by a second step change in October 2018 (-£0.018p per 100mL, 95%CI: -£0.033, -£0.001p). The volume of products in the higher levy group decreased at the time of the implementation (-305mL on average including multipacks, 95%CI: -511, -99). The change in trend for the product volume of drinks in the higher levy group between April 2018 and March 2020 was in the increasing direction (+704mL per year, 95%CI: -95, 1504), but it did not meet our threshold for statistical significance (p = 0.084). There were no changes observed in the volume of lower levy drinks or no levy drinks. There was a step change in the proportion of drinks with non-sugar sweeteners at the implementation of the SDIL (+0.04, 95%CI: +0.02, +0.06). CONCLUSION These results suggest that the SDIL was successful in [1] producing reductions in sugar levels that were maintained over the medium term up to March 2020 and [2] a reduction in product volume for higher tier drinks that may be diminishing over time. Our results also show that the SDIL was associated with a maintained price differential between high and low sugar drinks.
Collapse
Affiliation(s)
- Madison Luick
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Lauren K. Bandy
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Richard Harrington
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Jayalakshmi Vijayan
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mike Rayner
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - Nina Rogers
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Richard Smith
- Vice Chancellor’s Office, University of Exeter, Exeter, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Peter Scarborough
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| |
Collapse
|
2
|
Phaswana M, Mchiza ZJR, Onagbiye SO, Gradidge PJL. Obesity, beverage consumption and sleep patterns in rural African women in relation to advertising of these beverages. Int Health 2024:ihae031. [PMID: 38733569 DOI: 10.1093/inthealth/ihae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The burden of obesity-related, non-communicable diseases in South Africa is persistent, with poor and black South African women particularly vulnerable. The purpose of the present study was to determine relationships between obesity, physical activity, sleep patterns and beverage consumption among black South African women in a rural village in the Limpopo province. METHODS A cross-sectional study was conducted among 200 rural-dwelling African women. Data were collected on beverage consumption, sociodemographic information, sleep patterns and anthropometry using self-reported questionnaires. RESULTS The mean body mass index (BMI) was 28.5±7.3 kg/m2, with 40% being classified as obese (BMI ≥30 kg/m2) and the mean sleep score was 4.68±2.51. Participants with very bad habitual sleeping patterns consumed significantly more sugar-sweetened beverages and alcohol than those with very good sleeping patterns. We also observed that when total coffee with sugar, fruit juice, total sugar-sweetened beverages and weight decreased the number of hours participants slept increased. CONCLUSIONS The study identified significant associations between body weight, sleep duration and sugar-sweetened beverage consumption among rural black South African women. This underscores a need to address unhealthy lifestyle behaviours to lower incidences of non-communicable diseases in rural-dwelling women.
Collapse
Affiliation(s)
- Merling Phaswana
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zandile June-Rose Mchiza
- Non-Communicable Disease Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Tygerberg, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | | | - Philippe Jean-Luc Gradidge
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
3
|
Varghese B, Panicker R, Mukhopadhyay D, Backholer K, Sethi V, de Wagt A, Murira Z, Bhatia N, Arora M. Estimating the potential impact of a health tax on the demand for unhealthy food and beverages and on tax revenue in India. Health Policy Plan 2024; 39:299-306. [PMID: 38102765 DOI: 10.1093/heapol/czad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Foods high in fat, sugar or salt are important contributors to the rising burden of non-communicable diseases globally and in India. Health taxes (HTs) have been used by over 70 countries as an effective tool for reducing consumption of sugar sweetened beverages (SSBs). However, the potential impacts of HTs on consumption and on revenues have not been estimated in India. This paper aims to estimate the potential impact of health taxes on the demand for sugar, SSBs and foods high in fat, sugar or salt (HFSS) in India while exploring its impact on tax revenues. PE of sugar was estimated using Private Final Consumption Expenditure and Consumer Price Index data while price elasticities for SSBs and HFSS were obtained from literature. The reduction in demand was estimated for an additional 10-30% HT added to the current goods and services tax, for varying levels of price elasticities. The results show that for manufacturers of sweets and confectionaries who buy sugar in bulk and assuming a higher price elasticity of -0.70, 20% additional HT (total tax 48%) would result in 13-18% decrease in the demand for sugar used for confectionaries and sweets. For SSBs, HT of 10-30% would result in 7-30% decline in the demand of SSBs. For HFSS food products, 10-30% HT would result in 5-24% decline in the demand for HFSS products. These additional taxes would increase tax revenues for the government by 12-200% across different scenarios. Taxing unhealthy foods is likely to reduce demand, while increasing government revenues for reinvestment back into public health programmes and policies that may reduce obesity and the incidence of non-communicable diseases in India.
Collapse
Affiliation(s)
- Beena Varghese
- Indian Institute of Public Health, Public Health Foundation of India, Rajendra Nagar Mandal, Kismatpur, Hyderabad, Telangana 500030, India
| | - Rajashree Panicker
- Total Alliance Health Partners International, Dubai Healthcare City, Dubai 66566, UAE
| | - Dripto Mukhopadhyay
- Ascension Centre for Research and Analytics (ACRA), 5/1, Sector 5, Rajendra Nagar, Sahibabad, Ghaziabad, UP 201005, India
| | - Kathryn Backholer
- A/P Deakin University, Geelong, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Burwood, Victoria 3125, Australia
| | - Vani Sethi
- UNICEF Regional Office for South Asia, Kathmandu 5815, Nepal
| | | | - Zivai Murira
- UNICEF Regional Office for South Asia, Kathmandu 5815, Nepal
| | - Neena Bhatia
- Ministry of Health and Family Welfare, Government of India, New Delhi 110011, India
| | - Monika Arora
- Public Health Foundation of India, Gurgaon, Haryana 122102, India
| |
Collapse
|
4
|
Zhao Y, Chen W, Li J, Yi J, Song X, Ni Y, Zhu S, Zhang Z, Xia L, Zhang J, Yang S, Ni J, Lu H, Wang Z, Nie S, Liu L. Ultra-Processed Food Consumption and Mortality: Three Cohort Studies in the United States and United Kingdom. Am J Prev Med 2024; 66:315-323. [PMID: 37690589 DOI: 10.1016/j.amepre.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Given the increase in ultra-processed food (UPF) consumption, their potential health effects have aroused concern. Whether UPF consumption is associated with cancer and cardiovascular disease mortality is debatable. This study evaluates the association of UPF consumption with mortality. METHODS A total of 108,714 U.S. adults from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (1993-2001), 208,051 UK adults from UK Biobank (2006-2010), and 41,070 U.S. adults from National Health and Nutrition Examination Survey (1999-2018) were included. Dietary data were collected by dietary questionnaire and classified using the NOVA classification. UPF consumption was expressed as the weight proportion of UPFs in total foods consumed. Cox proportional hazard models were used to calculate hazard ratios and 95% CIs. Mediation analysis was used to evaluate whether multiple metabolic pathways mediated the associations in UK Biobank. Analyses were performed in 2022-2023. RESULTS Combined analyses of the three cohorts showed that those with the highest quartile of UPF consumption had higher risks of all-cause mortality (hazard ratio, 1.16; 95% CI, 1.11-1.20) and cardiovascular disease mortality (hazard ratio, 1.17; 95% CI, 1.06-1.28) compared to the lowest quartile of UPF consumption. UPF consumption was not associated with cancer mortality risk. Biomarkers of liver function have the greatest mediating effects on all-cause mortality (20.3%), and biomarkers of inflammation have the greatest mediating effects on cardiovascular disease mortality (29.2%). CONCLUSIONS Higher UPF consumption was associated with increased all-cause and cardiovascular disease mortality risk, with multiple metabolic pathways playing mediating roles.
Collapse
Affiliation(s)
- Yingying Zhao
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Weiyi Chen
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Jia Li
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Jing Yi
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Xuemei Song
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Yuxin Ni
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Sijia Zhu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Zhihao Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Lu Xia
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Jia Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Shuaishuai Yang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Jingjing Ni
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Haojie Lu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Zhen Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Li Liu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
| |
Collapse
|
5
|
Riediger ND, Neufeld T, Tait M, Turnbull L, Mann K, Waugh A, Bombak A. An examination of sugar-sweetened beverage tax regulations in six jurisdictions: Applying a social justice perspective to beverage taxation and exemptions. Glob Public Health 2024; 19:2394806. [PMID: 39183469 DOI: 10.1080/17441692.2024.2394806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
Taxes, legislation and politics are social determinants of health, which can impact health through multiple pathways. The purpose of this study was to review regulations regarding sugar-sweetened beverage (SSB) taxation and describe taxation/exemption of various beverage categories. We reviewed SSB taxation regulations from Mexico, the United Kingdom, Berkeley, Philadelphia, San Francisco and South Africa. Supplementary government documents and academic publications were also reviewed to further discern beverage taxation/exemption and zero-rating. There were a number of beverage types that fell clearly into typically taxed or exempt/zero-rated categories across all six jurisdictions (e.g. pop/soda as taxed and water as zero-rated). Exemptions and ambiguities within the six regulations can generally be grouped as a lack of clarity regarding the meaning and use of milk; the meaning of 'medical purposes' and 'supplemental'; the point at which a beverage is prepared; the form of concentrate (i.e. liquid/frozen/powder) or medium used (e.g. water, coffee); and location of preparation or business size of retailer. SSB tax regulations are complex, unclear, vary across jurisdiction and leave several beverage types with added sugar exempt from taxation or at risk of a legal challenge. Lastly, tax exemptions generally reflect and perpetuate existing sociopolitical dynamics within the food system.
Collapse
Affiliation(s)
- Natalie D Riediger
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Canada
| | - Tamara Neufeld
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Myra Tait
- Independent Scholar, Coleman, Canada
| | - Lorna Turnbull
- Faculty of Law, University of Manitoba, Winnipeg, Canada
| | - Kelsey Mann
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Canada
| | - Anne Waugh
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Canada
| | - Andrea Bombak
- Department of Sociology, University of New Brunswick, Fredericton, Canada
| |
Collapse
|
6
|
Madela SLM, Harriman NW, Sewpaul R, Mbewu AD, Williams DR, Sifunda S, Manyaapelo T, Nyembezi A, Reddy SP. Area-level deprivation and individual-level socioeconomic correlates of the diabetes care cascade among black south africans in uMgungundlovu, KwaZulu-Natal, South Africa. PLoS One 2023; 18:e0293250. [PMID: 38079422 PMCID: PMC10712896 DOI: 10.1371/journal.pone.0293250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
South Africa is experiencing a rapidly growing diabetes epidemic that threatens its healthcare system. Research on the determinants of diabetes in South Africa receives considerable attention due to the lifestyle changes accompanying South Africa's rapid urbanization since the fall of Apartheid. However, few studies have investigated how segments of the Black South African population, who continue to endure Apartheid's institutional discriminatory legacy, experience this transition. This paper explores the association between individual and area-level socioeconomic status and diabetes prevalence, awareness, treatment, and control within a sample of Black South Africans aged 45 years or older in three municipalities in KwaZulu-Natal. Cross-sectional data were collected on 3,685 participants from February 2017 to February 2018. Individual-level socioeconomic status was assessed with employment status and educational attainment. Area-level deprivation was measured using the most recent South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and hypertension diagnosis. The prevalence of diabetes was 23% (n = 830). Of those, 769 were aware of their diagnosis, 629 were receiving treatment, and 404 had their diabetes controlled. Compared to those with no formal education, Black South Africans with some high school education had increased diabetes prevalence, and those who had completed high school had lower prevalence of treatment receipt. Employment status was negatively associated with diabetes prevalence. Black South Africans living in more deprived wards had lower diabetes prevalence, and those residing in wards that became more deprived from 2001 to 2011 had a higher prevalence diabetes, as well as diabetic control. Results from this study can assist policymakers and practitioners in identifying modifiable risk factors for diabetes among Black South Africans to intervene on. Potential community-based interventions include those focused on patient empowerment and linkages to care. Such interventions should act in concert with policy changes, such as expanding the existing sugar-sweetened beverage tax.
Collapse
Affiliation(s)
| | - Nigel Walsh Harriman
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ronel Sewpaul
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Anthony David Mbewu
- Department of Internal Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - David R Williams
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of African and American Studies, Harvard University, Cambridge, Massachusetts, United States of America
| | - Sibusiso Sifunda
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | | | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | |
Collapse
|
7
|
Sackar SA, Apprey C, Aduku LNE, Thow AM, Annan R. Operationalising multi-sectoral food- and nutrition-related policies to curb the rise in obesity in Ghana. Public Health Nutr 2023; 26:3230-3238. [PMID: 36847129 PMCID: PMC10755410 DOI: 10.1017/s136898002300037x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/14/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To examine the governance of the food and nutrition policy space with particular reference to interests and power among stakeholders. DESIGN We followed a case study research design to conduct a nutrition policy analysis. We triangulated three sources of data: key-informant interviews, learning journey and relevant policy documents (2010-2020). This study is grounded in a conceptual framework focused on power. SETTING Ghana. PARTICIPANTS Key informants (n 28) drawn from policy stakeholders from government (Health, Agriculture, Trade and Industry), academia, civil society, development partners, civil society organisation (CSO) and private sector in Accra and Kumasi. RESULTS Power relations generated tensions, leading to weak multi-sectoral coordination among actors within the nutrition policy space. Governance and funding issues were identified as reasons for the weak multi-sectoral coordination. Formal power rested with government institutions while the private sector and CSO pushed to be invited during policy formulation. Visible stakeholders from industry were trade oriented and held a common interest of profit-making; they sought to receive support from government in order to be more competitive. There were no observed structures at the subnational levels for effective link with the national level. CONCLUSION Formal responsibility for decision making within the nutrition and food policy space rested with the health sector and bringing on board nutrition-related sectors remained a challenge due to power tensions. Establishing a National Nutrition Council, with structures at the subnational level, will strengthen policy coordination and implementation. Taxation of sugar-sweetened beverages could provide a fund generation avenue for coordination of programmes to curb obesity.
Collapse
Affiliation(s)
- Samuel Akwei Sackar
- Department of Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box KB143, Accra, Ghana
| | - Charles Apprey
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Linda Nana Esi Aduku
- College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Reginald Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
8
|
Nabyonga-Orem J, Christmals CD, Addai KF, Mwinga K, Karenzi-Muhongerwa D, Namuli S, Asamani JA. The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review. J Glob Health 2023; 13:04153. [PMID: 37962340 PMCID: PMC10644850 DOI: 10.7189/jogh.13.04153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Background Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation. Methods We conducted a systematic scoping review of the literature to analyze the nature, type, and factors impacting the implementation of innovative health financing mechanisms in the World Health Organization (WHO) African region. Results Innovative health financing mechanisms are increasing in the WHO African region as a result of international policy, the need to improve healthy eating and social life of the populace, advocacy and the availability of international mechanisms to which countries can subscribe. The 41 documents included in this review reported ten innovative financing mechanisms in 43 out of the 47 WHO Africa region member states. The most common mechanisms include an excise tax on tobacco products (43 countries) and alcoholic beverages and spirits (41 countries), airline ticket levy (18 countries), sugar-based beverages tax (seven countries), and levy on oil, gas and mineral tax (four countries). Other mechanisms include the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) trust fund, the social impact bond, the financial transaction tax, mobile phone tax and equity funds. Funds generated from many mechanisms are not allocated to health, although some portions are allocated to health-related activities. In some countries where mechanisms implemented are public health-related, emphasis is placed on positive health behavior beyond raising funds. Persistent resistance from industries due to conflicting economic policies is a major challenge. Conclusions Leveraging international policies and setting up intersectoral committees to develop and implement innovative mechanisms that involve excise taxes are recommended as possible solutions to the conflicts of interest.
Collapse
Affiliation(s)
- Juliet Nabyonga-Orem
- World Health Organization Regional office for Africa, Office of the Regional Director, Brazzaville, Congo
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Christmal D Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Kingsley F Addai
- World Health Organization Ghana country office, Universal Health Coverage Life Course Cluster, Accra, Ghana
| | - Kasonde Mwinga
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Diane Karenzi-Muhongerwa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Sylvia Namuli
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - James A Asamani
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| |
Collapse
|
9
|
Salgado Hernández JC, Basto-Abreu A, Junquera-Badilla I, Moreno-Aguilar LA, Barrientos-Gutiérrez T, Colchero MA. Building upon the sugar beverage tax in Mexico: a modelling study of tax alternatives to increase benefits. BMJ Glob Health 2023; 8:e012227. [PMID: 37963607 PMCID: PMC10649495 DOI: 10.1136/bmjgh-2023-012227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION In 2014, Mexico implemented a one peso-per-litre tax to sugar-sweetened beverage (SSB). Even though this tax reduced household purchases and predicted population health gains, the magnitude is lower compared with taxes implemented in other settings. In this study, we assessed what would happen if Mexico modified its existing tax to get higher benefits based on currently implemented taxes elsewhere. METHODS For each tax scenario, we estimated net benefits as the difference between healthcare savings and lost jobs. We created hypothetical scenarios in which the current tax doubled or would be modified based on existing tax designs around the world including specific taxes (sugar-density or volumetric) and ad-valorem taxes. RESULTS We found that the largest benefits would correspond to a tax increase of 7.4 Mexican pesos (0.45 US dollars (USD)) per SSB litre, following the current tax in Bahrain (the highest tax rate option). This tax is predicted to yield net benefits equivalent to USD 24.7 billion after 10 years of the tax redesign. We also found that sugar-density taxes can result in larger net benefits since, in addition to reductions in consumption associated with responses to prices, they induce product reformulation. Middle-income households are the most benefited group because they reported the highest baseline prevalence of obesity and the largest price elasticity. CONCLUSION Policymakers should consider pursuing a tax reform adding to the current tax, with significant increases in prices linked to a sugar-density strategy to reach a higher benefit.
Collapse
Affiliation(s)
- Juan Carlos Salgado Hernández
- National Council for Science and Technology and Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana Basto-Abreu
- Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Isabel Junquera-Badilla
- Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - M Arantxa Colchero
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Mexico
| |
Collapse
|
10
|
Mazonde N, Goldstein S. Online Health Communities' Portrayal of Obesity on Social Media Platforms in South Africa. JOURNAL OF HEALTH COMMUNICATION 2023; 28:15-24. [PMID: 38146160 DOI: 10.1080/10810730.2023.2231374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
The rapidly increasing prevalence of obesity in South Africa, intertwined with extensive changes in diet, life expectancy, and nutritional status has led to a complex framing of obesity on social media. This has prompted the prioritization of media-based social and behavior change communication interventions leveraging social media for obesity prevention. This study was conducted to understand how obesity is constructed and represented on social media in South Africa. A media review of Facebook and Twitter platforms in South Africa was conducted over a six-month period using Meltwater software for data collection. The search yielded 13 500 posts and tweets. Data were cleaned and coded in Microsoft Excel. Content and framing analysis were performed to add insight into the nature of obesity discourse on social media. Portrayals of obesity on social media were dominated by stigmatizing imagery blaming individuals for unhealthy lifestyles, poor diets, and lack of physical activity. Future media-based social and behavior change communication interventions for obesity prevention can leverage social media to reach the broader public and insights into media portrayals of obesity have the potential to influence the shape and development of these behavioral interventions.
Collapse
Affiliation(s)
- Natasha Mazonde
- SAMRC/Wits Centre for Health Economics & Decision Science- PRICELESS-SA, University of Witwatersrand, Faculty of Health Sciences, School of Public Health, Parktown Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC/Wits Centre for Health Economics & Decision Science- PRICELESS-SA, University of Witwatersrand, Faculty of Health Sciences, School of Public Health, Parktown Johannesburg, South Africa
| |
Collapse
|
11
|
Barnett-Naghshineh O, Warmington S, Altink H, Govia I, Morrissey K, Smith MJ, Thurstan RH, Unwin N, Guell C. Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica. Global Health 2023; 19:69. [PMID: 37700357 PMCID: PMC10498565 DOI: 10.1186/s12992-023-00962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake? METHODS An ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team. RESULTS We emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica's long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations. CONCLUSION The contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.
Collapse
Affiliation(s)
| | - Sheray Warmington
- Epidemiology Research Unit, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, 7, Jamaica
| | - Henrice Altink
- Department of History and Interdisciplinary Global Development Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, 7, Jamaica
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Karyn Morrissey
- Climate and Energy Policy, Department of Technology, Management and Economics, Technical University Denmark, Kgs. Lyngby, 2800, Denmark
| | - Matthew J Smith
- Department of History, University College London, London, WC1E 6BT, UK
| | - Ruth H Thurstan
- Centre for Ecology and Conservation, University of Exeter, Penryn, TR10 9FE, UK
| | - Nigel Unwin
- European Centre for Environment and Human Health, University of Exeter, Penryn, TR10 9FE, UK
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0SL, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter, Penryn, TR10 9FE, UK.
| |
Collapse
|
12
|
Darsamo V, Walbeek C. Effect of price and income on the demand for sugar-sweetened beverages in Nigeria: an analysis of household consumption data using an almost ideal demand system (AIDS). BMJ Open 2023; 13:e072538. [PMID: 37527896 PMCID: PMC10394539 DOI: 10.1136/bmjopen-2023-072538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES To estimate the own-price, cross-price and income elasticities for carbonated soft drinks (CSDs), malt drinks, chocolate powder, sachet water and sugar in Nigeria. These elasticities can be used to estimate the potential demand response to the recently-introduced sugar tax in Nigeria. SETTING The study uses household data from the 2018/2019 Nigeria Living Standards Survey (NLSS). PARTICIPANTS The NLSS is a national household survey. 21 114 households were included in the final sample for this analysis. PRIMARY AND SECONDARY OUTCOMES We used Deaton's almost ideal demand system, which controls for the goods' quality, to estimate the effect of price and income changes on the demand for CSDs, chocolate powder, malt drinks, sachet water and sugar. RESULTS We found that the own-price elasticity (ordered from most to least price-responsive) was -0.99 (p<0.01) for sachet water, -0.76 (p<0.01) for CSDs, -0.72 (p<0.01) for chocolate powder, -0.62 (p<0.01) for sugar and -0.19 (p<0.01) for malt drinks. The cross-price elasticities indicate that malt drinks and chocolate powders are substitutes of CSDs. The income elasticities indicate that all the commodities are normal goods. Sachet water had the highest income elasticity at 0.62 (p<0.01), followed by chocolate powder at 0.54 (p<0.01), CSDs at 0.47 (p<0.01), malt drinks at 0.43 (p<0.01) and sugar at 0.13 (p<0.01). CONCLUSION Even though the price elasticities for CSDs, malt drinks and chocolate powder are less than one, in absolute terms, they are significantly different from zero. Increases in the sugar-sweetened beverage tax could curb the demand for these beverages, and, in turn, reduce the incidence and prevalence of sugar-attributable diseases.
Collapse
Affiliation(s)
- Vanessa Darsamo
- Research Unit on the Economics of Excisable Products (REEP), School of Economics, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Corne Walbeek
- Research Unit on the Economics of Excisable Products (REEP), School of Economics, University of Cape Town, Cape Town, Western Cape, South Africa
| |
Collapse
|
13
|
Hangoma P, Chewe M. Should We Worry About Spillover Effects of Sugar Sweetened Beverage Taxation Policies? Comment on "Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019". Int J Health Policy Manag 2023; 12:7793. [PMID: 37579383 PMCID: PMC10461933 DOI: 10.34172/ijhpm.2023.7793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/17/2023] [Indexed: 08/16/2023] Open
Abstract
Taxes on sugar sweetened beverages (SSBs) have been widely implemented and heralded as a panacea in reversing the growing burden of non-communicable diseases (NCDs). Using a qualitative research methodology, Forde et al explored how sugary drink companies respond to changes in taxation positing that relative effectiveness of sugar taxes will not only depend on how prices are affected, and how consumers respond, but also how producers respond by reformulating their products or engaging in counteractive marketing strategies. They argue that these responses may undermine the public health goal. We discuss some of the key issues that arise in their paper and conclude that company responses may not be sufficient in undermining the public health goal, and that consumption of sugary drinks fall after imposition of taxes, though demand is inelastic. We argue that inelasticity of demand for SSB may require a combination of interventions to sufficiently reduce excess consumption of sugar drinks.
Collapse
Affiliation(s)
- Peter Hangoma
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Chr. Michelsens Institute (CMI), Bergen, Norway
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), University of Bergen, Bergen, Norway
| | - Mwimba Chewe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| |
Collapse
|
14
|
Melo G, Aguilar-Farias N, López Barrera E, Chomalí L, Moz-Christofoletti MA, Salgado JC, Swensson LJ, Caro JC. Structural responses to the obesity epidemic in Latin America: what are the next steps for food and physical activity policies? LANCET REGIONAL HEALTH. AMERICAS 2023; 21:100486. [PMID: 37096192 PMCID: PMC10122054 DOI: 10.1016/j.lana.2023.100486] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/12/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
Obesity is among the most complex public health challenges, particularly in Latin America, where obesity rates have increased faster than in any other region. Many countries have proposed or enacted comprehensive policies to promote adequate diet and physical activity under a structural framework. We summarize articles discussing the scope and impact of recently implemented obesity-related interventions in the light of a structural response framework. Overall, we find that: (1) market-based food interventions, including taxes on junk food, nutrition labelling, and marketing restrictions, decrease the consumption of targeted foods, (2) programs directly providing healthy foods are effective in reducing obesity, and (3) the construction of public areas for recreation increases the average frequency of physical activity. Although obesity-related interventions in the region have somewhat improved health behaviours, obesity prevalence remains on an upward trend. We discuss some opportunities to continue tackling the obesity epidemic in LATAM under a structural framework.
Collapse
Affiliation(s)
- Grace Melo
- Accountability, Climate, Equity, and Scholarship (ACES), Department of Agricultural Economics, Texas A&M, College Station, TX, USA
| | - Nicolas Aguilar-Farias
- Department of Physical Education, Sports and Recreation, Universidad de la Frontera, Chile
| | | | | | | | - Juan Carlos Salgado
- Center for Nutrition and Health Research, National Institute of Public Health and National Council for Science and Technology, Mexico
| | - Luana Joppert Swensson
- Policy and Legal Specialist for Sustainable Public Procurement, Food and Agriculture Organization, Italy
| | - Juan Carlos Caro
- Department of Industrial Engineering, University of Concepción, Chile
- Corresponding author. Department of Industrial Engineering, University of Concepción, Chile, Edmundo Larenas 219, Concepción, Chile.
| |
Collapse
|
15
|
O'Hearn M, Lara-Castor L, Cudhea F, Miller V, Reedy J, Shi P, Zhang J, Wong JB, Economos CD, Micha R, Mozaffarian D. Incident type 2 diabetes attributable to suboptimal diet in 184 countries. Nat Med 2023; 29:982-995. [PMID: 37069363 PMCID: PMC10115653 DOI: 10.1038/s41591-023-02278-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 04/19/2023]
Abstract
The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8-14.4 million) incident T2D cases, representing 70.3% (68.8-71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0-27.1%)), excess refined rice and wheat intake (24.6% (22.3-27.2%)) and excess processed meat intake (20.3% (18.3-23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4-87.7%)) and Latin America and the Caribbean (81.8% (80.1-83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1-60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.
Collapse
Affiliation(s)
- Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Food Systems for the Future Institute, Chicago, IL, USA.
| | - Laura Lara-Castor
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Julia Reedy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - John B Wong
- Tufts University School of Medicine, Boston, MA, USA
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Food Science and Nutrition, University of Thessaly, Volos, Greece
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
| |
Collapse
|
16
|
Boachie MK, Goldstein S, Kruger P, Ng SW, Hofman KJ, Thsehla E. Beverage industry's advertising expenditures and airtimes in South Africa from 2013 to 2019 target children and families. J Public Health Res 2023; 12:22799036231168207. [PMID: 37122639 PMCID: PMC10134126 DOI: 10.1177/22799036231168207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
With the growing burden of non-communicable diseases (NCDs), countries across the globe are finding ways to reduce the consumption of ultra-processed food and drinks including sugar-sweetened beverages (SSBs). South Africa implemented a health promotion levy (HPL) in April 2018 as one strategy to reduce sugar intake. Such efforts are frequently countered or mitigated by industry action in various ways, including through marketing and advertising strategies. To better understand trends in the extent of advertising, this paper analyses advertising expenditures and exposure of children to SSB advertisements in South Africa. Using Nielsen's monthly data on advertising expenditure before and after the introduction of the HPL, for the period January 2013 to April 2019, the results show that manufacturers spent ZAR 3683 million to advertise their products. Advertising expenditure on carbonated drinks accounted for over 60% (ZAR 2220 million) of the total expenditure on SSBs. The results also show that companies spend less in advertising powdered SSBs (an average of ZAR 0.05 million per month). Based on expenditure patterns, television (TV) was the preferred medium of advertisements, with companies prioritizing what is often considered children's and family viewing time. Urgent mandatory regulations are needed to prevent child-directed marketing.
Collapse
Affiliation(s)
- Micheal Kofi Boachie
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Micheal Kofi Boachie, SAMRC/Wits Centre for
Health Economics and Decision Science – PRICELESS SA, School of Public Health,
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193,
South Africa.
| | - Susan Goldstein
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Petronell Kruger
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shu Wen Ng
- Department of Nutrition, Gillings
School of Global Public Health, University of North Carolina, Chapel Hill, NC,
USA
| | - Karen J Hofman
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
17
|
Salgado Hernández JC, Ng SW, Colchero MA. Changes in sugar-sweetened beverage purchases across the price distribution after the implementation of a tax in Mexico: a before-and-after analysis. BMC Public Health 2023; 23:265. [PMID: 36750794 PMCID: PMC9906831 DOI: 10.1186/s12889-023-15041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/12/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND A tax of one-Mexican peso per liter of sugar-sweetened beverage (SSB) came into effect in January 2014 in Mexico as a national health policy to tackle the high overweight and obesity prevalence. Previous studies have shown an overall reduction in SSB purchases after the tax implementation. However, it remains unknown whether and to what extent SSB consumers switched to cheaper taxed beverages, attenuating the potential effect of the policy. Our study's objective was to estimate changes in household purchases of taxed SSBs by tertiles of SSB prices (low, middle, and high) in urban areas after the SSB tax implementation in 2014. METHODS Based on purchase data for 2012-2015 from households living in 54 Mexican cities with a population > 50,000 inhabitants, we calculated unit-value SSB prices for the full period and sorted them on a monthly basis to create monthly price tertiles. We merged these price tertiles to household purchases and created average monthly ml/capita/day SSB purchases by price tertile at the city level. We assessed SSB purchase switching patterns before and after the tax implementation through price-tertile stratified linear models. The main variable in the models was a dummy indicator that allowed us to identify the pre-tax period (2012-13) and post-tax period (2014-15). We controlled our models for time trends and contextual economic variables. RESULTS In the regression adjusted models, we found a statistically significant purchase reduction ranging between 10.80 and 13.79 ml/capita/day (p-value < 0.001) across taxed beverages from the middle-price SSB after the tax implementation. We observed no statistically significant reductions in purchases of low-price SSBs and high-price SSBs. CONCLUSIONS Our findings show purchase reductions in the middle-price SSBs, which represents ≈30% of the overall SSB purchases in urban Mexico. Future studies should be conducted to test if the redesign of the current the tax, by either doubling the tax amount or taxing sugar content, might reduce more effectively purchases across all SSBs.
Collapse
Affiliation(s)
- J. C. Salgado Hernández
- grid.415771.10000 0004 1773 4764National Council for Science and Technology and Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Universidad No 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos Y Caminera. CP 62100, Cuernavaca, Morelos México
| | - S. W. Ng
- grid.10698.360000000122483208Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill and Carolina Population Center, CB #8120, 123 West Franklin Street, Chapel Hill, NC 27516 USA
| | - M. A. Colchero
- grid.415771.10000 0004 1773 4764Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos Y Caminera. CP 62100, Cuernavaca, Morelos, México
| |
Collapse
|
18
|
Boachie MK, Thsehla E, Immurana M, Kohli-Lynch C, Hofman KJ. Estimating the healthcare cost of overweight and obesity in South Africa. Glob Health Action 2022; 15:2045092. [PMID: 35389331 PMCID: PMC9004491 DOI: 10.1080/16549716.2022.2045092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Overweight and obesity are major risk factors for noncommunicable diseases. This presents a major burden to health systems and to society in South Africa. Collectively, these conditions are overwhelming public healthcare. This is happening when the country has embarked on a journey to universal health coverage, hence the need to estimate the cost of overweight and obesity. Objective Our objective was to estimate the healthcare cost associated with treatment of weight-related conditions from the perspective of the South African public sector payer. Methods Using a bottom-up gross costing approach, this study draws data from multiple sources to estimate the direct healthcare cost of overweight and obesity in South Africa. Population Attributable Fractions (PAF) were calculated and multiplied by each disease’s total treatment cost to apportion costs to overweight and obesity. Annual costs were estimated for 2020. Results The total cost of overweight and obesity is estimated to be ZAR33,194 million in 2020. This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is ZAR2,769. The overweight and obesity cost is disaggregated as follows: cancers (ZAR352 million), cardiovascular diseases (ZAR8,874 million), diabetes (ZAR19,861 million), musculoskeletal disorders (ZAR3,353 million), respiratory diseases (ZAR360 million) and digestive diseases (ZAR395 million). Sensitivity analyses show that the total overweight and obesity cost is between ZAR30,369 million and ZAR36,207 million. Conclusion This analysis has demonstrated that overweight and obesity impose a huge financial burden on the public health care system in South Africa. It suggests an urgent need for preventive, population-level interventions to reduce overweight and obesity rates. The reduction will lower the incidence, prevalence, and healthcare spending on noncommunicable diseases.
Collapse
Affiliation(s)
- Micheal Kofi Boachie
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Ciaran Kohli-Lynch
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois, USA
| | - Karen J Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
19
|
Are intentions to change, policy awareness, or health knowledge related to changes in dietary intake following a sugar-sweetened beverage tax in South Africa? A before-and-after study. Int J Behav Nutr Phys Act 2022; 19:136. [PMID: 36307849 PMCID: PMC9617427 DOI: 10.1186/s12966-022-01370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In April 2018, South Africa implemented the Health Promotion Levy (HPL), one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100mL). The objectives of this study were to examine whether the psychological constructs tax awareness, SSB knowledge, SSB risk perception, and intentions to reduce SSB intake were associated with taxed beverage intake, whether they changed from pre- to post-tax, and whether they modified the effect of the HPL. METHODS We collected single day 24-hour dietary recalls surveyed from repeat cross-sectional surveys of adults aged 18-39 years in Langa, South Africa. Participants were recruited in February-March 2018 (pre-tax, N = 2,481) and February-March 2019 (post-tax, N = 2,507) using door-to-door sampling. Surveys measured tax awareness, SSB knowledge, SSB risk perception, and intention to reduce SSB intake. SSB intake was estimated using a two-part model. To examine changes over time, logistic regression models were used for binary outcomes (tax awareness and intention to reduce SSB consumption) and linear regression models for continuous outcomes (SSB knowledge SSB risk perceptions). Effect modification was tested using interaction terms for each psychological construct with time. RESULTS No constructs were associated with SSB intake at baseline. At post-tax, the predicted probability to consume taxed beverages was 33.5% (95% CI 28.5-38.5%) for those who expressed an intention to reduce SSB intake compared to 45.9% (95% CI 43.7-48.1%) for those who did not. Among consumers, intending to reduce SSB intake was associated with 55 (95% CI 28 to 82) kcal/capita/day less SSBs consumed. Tax awareness, SSB knowledge, and SSB risk perception increased by a small amount from pre- to post-tax. Intentions to reduce SSB intake was lower in the post-tax period. The tax effect on SSB intake was modified by SSB knowledge and intention to reduce SSB intake, with higher levels of each associated with lower SSB intake. CONCLUSION After the South African SSB tax was implemented, SSB knowledge and risk perception increased slightly, tax awareness remained low, and only SSB knowledge and behavioral intention to change were significantly associated with taxed beverage intake among participants recruited from a low-income South African township.
Collapse
|
20
|
Koen N, Ebrahim Z, Louisa Marais M, Nel D, Smit Y. Taxation of sugar-sweetened beverages in South Africa: Perspectives of consumers in Cape Town. J Public Health Res 2022; 11:22799036221129369. [PMID: 36310822 PMCID: PMC9597050 DOI: 10.1177/22799036221129369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Globally, fiscal measures are deemed effective in combating the obesity epidemic at population level. A health promotional levy (HPL) on sugar sweetened beverages (SSBs) was implemented in April 2018 in South Africa to reduce sugar consumption. DESIGN AND METHODS This cross-sectional, descriptive study investigated consumers' understanding and opinion of the HPL, and impact on consumption of SSBs. Data was collected outside 15 grocery stores, within four health sub-districts of the City of Cape Town. An interviewer-administered questionnaire was completed with literate, adult consumers (N = 696). RESULTS Participants (46.0%) were aware of the HPL but regarded it insufficient to change purchasing behaviour (55.4%). The lower income group (56.4%) was most affected by the increased price of SSBs. Those who agreed (46.8%) that the levy would help to reduce the prevalence of obesity was significantly more likely to notice a price increase in SSBs (54.5%) (p < 0.01) and had a higher education level (p < 0.01). Overall, self-reported consumption of SSBs decreased by 7.7% since the HPL was enacted. Participants who were aware of the detrimental effect of consuming large amounts of sugar, were more likely to change their behaviour (p < 0.01). CONCLUSIONS Participants were receptive for legislative measures to combat the prevalence of obesity but lacked clarity of the goal and implementation of the HPL. A multipronged approach is crucial to lower sugar intake sustainably and an environment which offers healthy alternatives to SSBs. A higher HPL combined with transparency of how revenue is utilised could enhance the impact of the sugar tax strategy.
Collapse
Affiliation(s)
- Nelene Koen
- Division of Human Nutrition, Department
of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa,Nelene Koen, Division of Human Nutrition,
Department of Global Health, Faculty of Medicine and Health Sciences,
Stellenbosch University, PO Box 241, Cape Town 8000, South Africa.
| | - Zarina Ebrahim
- Division of Human Nutrition, Department
of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa
| | - Maritha Louisa Marais
- Division of Human Nutrition, Department
of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa
| | - Daan Nel
- Centre for Statistical Consultation,
Stellenbosch University, Stellenbosch, South Africa
| | - Yolande Smit
- Division of Human Nutrition, Department
of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa
| |
Collapse
|
21
|
Tak M, Law C, Green R, Shankar B, Cornelsen L. Processed foods purchase profiles in urban India in 2013 and 2016: a cluster and multivariate analysis. BMJ Open 2022; 12:e062254. [PMID: 36207045 PMCID: PMC9558783 DOI: 10.1136/bmjopen-2022-062254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Sales of ultraprocessed foods (UPFs) and beverages are rising in low-income and middle-income countries. Such foods are often linked with weight gain, obesity, type 2 diabetes and hypertension-diseases that are on the rise in India. This paper analysed patterns in purchases of processed and UPF by urban Indian households. SETTING Panel data from Kantar -Worldpanel Division, India for 2013 and 2016. PARTICIPANTS 58 878 urban Indian households. METHODS We used K-mean partition clustering and multivariate regression to analyse patterns in processed food (PF) and UPF purchase for urban India. RESULTS Three-quarters of urban Indian households purchased over ten PF groups. Mean per person annual PF purchase was 150 kg. UPF purchase was low at 6.4 kg in 2016 but had grown by 6% since 2013. Cluster analysis identified three patterns of consumption, characterised by low (54% of the households in 2016), medium (36%) and high (10%) PF purchase quantities. High cluster households purchased over three times as much PFs and UPF as the low cluster households. Notably, salt purchases were persistently high across clusters in both years (>3.3 kg), while sweet snack and ready-to-eat food purchases grew consistently in all clusters between 2013 and 2016. A positive and significant association was found between household purchases of UPF and their socioeconomic status as well as ownership of durables, such as refrigerator, colour television and washing machine (all p<0.001). Spatial characteristics including size of town (p<0.05) in which the household is located were also positively associated with the purchase of UPF. CONCLUSION Results suggest the need for tailored regional and city level interventions to curb the low but growing purchase of UPF. New data on obesity and rise of non-communicable diseases, the results are concerning given the links between lifestyle changes and the speed of urbanisation in Indian cities.
Collapse
Affiliation(s)
- Mehroosh Tak
- Veterinary Epidemiology, Economics and Public Health, The Royal Veterinary College, London, UK
| | - Cherry Law
- Department of Agri-Food Economics and Marketing, School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Rosemary Green
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Institute for Sustainable Food, University of Sheffield, Sheffield, UK
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
22
|
Bercholz M, Ng SW, Stacey N, Swart EC. Decomposing consumer and producer effects on sugar from beverage purchases after a sugar-based tax on beverages in South Africa. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101136. [PMID: 35358759 PMCID: PMC9288974 DOI: 10.1016/j.ehb.2022.101136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 02/05/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Growing global concern about obesity and diet-related non-communicable diseases has raised interest in fiscal policy as a tool to reduce this disease burden and its social costs, especially excise taxes on sugar-sweetened beverages (SSBs). Of particular interest have been nutrient-based taxes to improve diet quality. These can incentivize producers to reformulate existing products and introduce healthier alternatives into their ranges. In 2018, South Africa adopted a sugar-based tax on SSBs, the Health Promotion Levy (HPL). Early findings suggest that purchases of higher-sugar taxable beverages fell and purchases of no- and lower-sugar beverages increased, alongside significant reductions in the sugar content of overall beverage purchases. However, underlying these changes are consumption shifts as well as product reformulation and changes in producers' product portfolios. Drawing on a household scanner dataset, this study employed a descriptive approach to decompose changes in the sugar content of households' non-alcoholic beverage purchases into producer factors (reformulation and product entry and exit) and consumer factors (product switching and volume changes as a result of price changes, changing preferences, or other factors). We look at these factors as the tax was announced and implemented across a sample of over 3000 South African households, and then by Living Standard Measures (LSM) groups (middle vs. high). The sugar content of beverage purchases fell by 4.9 g/capita/day overall, a 32% decrease. Taken in isolation, consumer switching and volume changes together led to a reduction equivalent to 71% of the total change, while reformulation accounted for a decrease equal to 34% of that change. Middle-LSM households experienced larger reductions than high-LSM households due to larger changes on the consumer side. For both LSM groups, reformulation-led reductions mostly occurred after implementation, and most changes came from taxable beverage purchases. As sugary drink tax designs evolve with broader implementation globally, understanding both supply- and demand-side factors will help to better assess the population and equity potential of these policies.
Collapse
Affiliation(s)
- Maxime Bercholz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates.
| | - Nicholas Stacey
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa; DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
23
|
Micklesfield LK, Kolkenbeck-Ruh A, Mukoma G, Prioreschi A, Said-Mohamed R, Ware LJ, Motlhatlhedi M, Wrottesley SV, Norris SA. The Healthy Aging Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women. Cardiovasc J Afr 2022; 33:200-219. [PMID: 35789240 PMCID: PMC9650148 DOI: 10.5830/cvja-2022-015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/14/2022] [Indexed: 10/03/2023] Open
Abstract
Due to the increasing non-communicable disease burden in Africa, several strategies that target the major lifestyle and physiological risk factors have been implemented to combat such diseases. The Healthy Aging Adult South Africa report card systematically reviews national and regional prevalence data of middle-aged South African adults (45-65 years) published between 2013 and 2020 on diet, physical activity, tobacco use and alcohol consumption, obesity, hypertension, dyslipidaemia and diabetes mellitus. Each indicator was assigned two grades, (1) based on the availability of prevalence data, and (2) based on whether policies have been proposed and implemented for the respective indicators. Alcohol consumption, obesity, hypertension and diabetes received an A grade for the availability of prevalence data. Tobacco use and diet received an A grade for policy and implementation. Gaps have been identified that need to be filled by future research focusing on continued surveillance of all indicators in order to inform and implement effective policies.
Collapse
Affiliation(s)
- Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gudani Mukoma
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
24
|
New developments with the Health Promotion Levy in South Africa. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.16579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
25
|
Rebolledo N, Reyes M, Popkin BM, Adair L, Avery CL, Corvalán C, Ng SW, Taillie LS. Changes in nonnutritive sweetener intake in a cohort of preschoolers after the implementation of Chile's Law of Food Labelling and Advertising. Pediatr Obes 2022; 17:e12895. [PMID: 35088571 DOI: 10.1111/ijpo.12895] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/10/2021] [Accepted: 01/11/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The first phase of Chile's Law of Food Labelling and Advertising showed important declines in the sugar content of packaged foods, but it is unknown whether the law led to an increase in nonnutritive sweetener (NNS) intake, particularly among preschool children. OBJECTIVES Estimate the changes in preschoolers' NNS intake after the first phase of the Chilean law. METHODS We used 24-h dietary recalls collected in 2016 (pre-law) and 2017 (post-law) from a cohort of preschoolers (n = 875). The primary caretaker was the respondent of the recalls. Information on NNS was obtained from nutrition facts panels collected annually and linked to dietary data. We used logistic regression to estimate the changes in the proportion of preschoolers who consume NNS and two-part models to estimate the changes in mean intake. We determined the percentage of children that surpassed the acceptable daily intake (ADI) of each NNS using the National Cancer Institute method. RESULTS The proportion of consumers of at least one NNS increased from 77.9% to 92.0% (p-value < 0.01). The mean intake increased for sucralose, aspartame, acesulfame-K and steviol glycosides (+20.3, +15.1, +6.1 and +3.3 mg/day, respectively). In addition, NNS dietary sources changed for sucralose and steviol glycosides, becoming industrialized juices and dairy beverages more relevant while tabletop NNS became less relevant. None of the children surpassed the ADI. CONCLUSIONS NNS intake increased in preschoolers after the first phase of a national policy that promoted sugar reformulation.
Collapse
Affiliation(s)
- Natalia Rebolledo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marcela Reyes
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christy L Avery
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
26
|
Petimar J, Gibson LA, Yan J, Bleich SN, Mitra N, Trego ML, Lawman HG, Roberto CA. Sustained Impact of the Philadelphia Beverage Tax on Beverage Prices and Sales Over 2 Years. Am J Prev Med 2022; 62:921-929. [PMID: 35221175 PMCID: PMC9124672 DOI: 10.1016/j.amepre.2021.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is unclear whether changes in beverage price and sales after beverage tax implementation can be sustained long term. This study aims to quantify the changes in beverage prices and sales in large retailers 2 years after the implementation of the 1.5 cents per ounce Philadelphia beverage tax. METHODS Data on price and volume sales of beverages and potential food substitutes were collected from 109 supermarkets, 45 mass merchandizers, and 350 pharmacies in Philadelphia, Baltimore (control), and Pennsylvania ZIP codes bordering Philadelphia (to investigate potential cross-border shopping for tax avoidance). Difference-in-differences analyses compared beverage prices and volume sales in the year before tax implementation (2016) to 2 years after (2018). Data were analyzed in 2020-2021. RESULTS Difference-in-differences analyses found that after tax implementation, taxed beverage prices in Philadelphia increased by 1.02 cents per ounce (95% CI=0.94, 1.11; 68% pass through), and taxed beverage volume sales in stores decreased by 50% (95% CI=36%, 61%). After accounting for cross-border shopping, taxed beverage volume sales decreased in Philadelphia by 35% in 2018. Volume sales of nontaxed beverages did not change after tax implementation (difference-in-differences=4%, 95% CI= -3%, 12%). Volume sales of nontaxed beverage concentrates increased on average by 34% (95% CI=19%, 51%), but there was no evidence of substitution to high-calorie foods. CONCLUSIONS There was a large reduction in taxed beverage volume sales 2 years after Philadelphia tax implementation, even after accounting for cross-border shopping. Increases in nontaxed beverage concentrate sales likely partially offset this decline, but there was no evidence of post-tax food substitution.
Collapse
Affiliation(s)
- Joshua Petimar
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Laura A Gibson
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jiali Yan
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marsha L Trego
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hannah G Lawman
- Division of Chronic Disease & Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
27
|
Acton RB, Vanderlee L, Adams J, Kirkpatrick SI, Pedraza LS, Sacks G, White CM, White M, Hammond D. Tax awareness and perceived cost of sugar-sweetened beverages in four countries between 2017 and 2019: findings from the international food policy study. Int J Behav Nutr Phys Act 2022; 19:38. [PMID: 35361251 PMCID: PMC8973878 DOI: 10.1186/s12966-022-01277-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/24/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The public health benefits of sugar-sweetened beverage (SSB) taxes often rely on, among other things, changes to consumer purchases. Thus, perceived cost of SSBs and signalling effects-via awareness of the tax-may impact the effectiveness of SSB taxes on consumer purchases. OBJECTIVE The study sought to examine perceived cost of SSBs, tax awareness, and changes in beverage purchasing over time and across four countries with and without SSB taxes. METHODS The study used data from the 2017, 2018 and 2019 waves of the International Food Policy Study. Annual cross-sectional online surveys were conducted in Australia, Mexico, UK and US, which captured perceived cost of SSBs relative to non-SSBs in all countries (with Australia as a no-tax comparator), and measures of tax awareness and participants' reported changes in beverage purchasing in response to SSB taxes in Mexico (tax implemented in 2014), UK (tax implemented in 2018) and US (subnational taxes since 2015). Logistic regression models evaluated the measures across years and socio-demographic groups. RESULTS Perceived cost of SSBs relative to non-SSBs was higher in Mexico (all three years) and the UK (2018 and 2019 following tax implementation) than Australia and the US. Tax awareness was higher in UK than Mexico, and decreased over time among Mexican respondents. Patterns of reported beverage purchasing changes in response to the tax were similar across Mexico, UK and US, with the largest changes reported by Mexican respondents. Respondents with characteristics corresponding to lower socioeconomic status were less likely to be aware of an SSB tax, but more likely to perceive SSBs to cost more than non-SSBs and report changes in purchasing in response to the tax, where there was one. CONCLUSIONS This study suggests that in countries where a national SSB tax was present (Mexico, UK), perceived cost of SSBs and tax awareness were higher compared to countries with no SSB tax (Australia) or subnational SSB taxes (US), respectively, and suggests that perceived cost and tax awareness represent distinct constructs. Improving the 'signalling effect' of existing SSB taxes may be warranted, particularly in tax settings where consumer behaviour change is a policy objective.
Collapse
Affiliation(s)
- Rachel B Acton
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé Et Société (NUTRISS), Université Laval, 2425 rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Jean Adams
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lilia S Pedraza
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Col. Santa María Ahuacatitlán, Cerrada los Pinos Y Caminera, Av. Universidad 655, C.P. 62100, Morelos, Mexico
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Melbourne Burwood Campus, Burwood, VIC, 3125, Australia
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Martin White
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| |
Collapse
|
28
|
Laar AK, Addo P, Aryeetey R, Agyemang C, Zotor F, Asiki G, Rampalli KK, Amevinya GS, Tandoh A, Nanema S, Adjei AP, Laar ME, Mensah K, Laryea D, Sellen D, Vandevijvere S, Turner C, Osei-Kwasi H, Spires M, Blake C, Rowland D, Kadiyala S, Madzorera I, Diouf A, Covic N, Dzudzor IM, Annan R, Milani P, Nortey J, Bricas N, Mphumuzi S, Anchang KY, Jafri A, Dhall M, Lee A, Mackay S, Oti SO, Hofman K, Frongillo EA, Holdsworth M. Perspective: Food Environment Research Priorities for Africa-Lessons from the Africa Food Environment Research Network. Adv Nutr 2022; 13:739-747. [PMID: 35254411 PMCID: PMC9156374 DOI: 10.1093/advances/nmac019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 02/03/2023] Open
Abstract
Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition-obesity and other diet-related noncommunicable diseases (DR-NCDs)-along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food environments. However, in Africa, the necessary research and policy action have received insufficient attention. Contextual evidence to motivate, enable, and create supportive food environments in Africa for better population health is urgently needed. In November 2020, the Measurement, Evaluation, Accountability, and Leadership Support for Noncommunicable Diseases Prevention Project (MEALS4NCDs) convened the first Africa Food Environment Research Network Meeting (FERN2020). This 3-d virtual meeting brought researchers from around the world to deliberate on future directions and research priorities related to improving food environments and nutrition across the African continent. The stakeholders shared experiences, best practices, challenges, and opportunities for improving the healthfulness of food environments and related policies in low- and middle-income countries. In this article, we summarize the proceedings and research priorities identified in the meeting to advance the food environment research agenda in Africa, and thus contribute to the promotion of healthier food environments to prevent DR-NCDs, and other forms of malnutrition.
Collapse
Affiliation(s)
| | - Phyllis Addo
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Richmond Aryeetey
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Krystal K Rampalli
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Gideon S Amevinya
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Akua Tandoh
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Silver Nanema
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Akosua Pokua Adjei
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Matilda E Laar
- Department of Family and Consumer Sciences, School of Agriculture, University of Ghana, Accra, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, University of Ghana, Legon, Accra, Ghana
| | - Dennis Laryea
- Non-Communicable Disease Programme, Ghana Health Service, Accra, Ghana
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | | | - Christopher Turner
- Department of Food and Markets, University of Greenwich, Greenwich, United Kingdom
| | - Hibbah Osei-Kwasi
- Geography Department, University of Sheffield, Sheffield, United Kingdom
| | - Mark Spires
- Centre for Food Policy, City University of London, London, United Kingdom
| | - Christine Blake
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dominic Rowland
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Isabel Madzorera
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Adama Diouf
- Nutrition Laboratory, Department of Animal Biology, Faculty of Science and Technology, University Cheikh Anta Diop, Dakar, Senegal
| | - Namukolo Covic
- International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Isaac M Dzudzor
- Center for Development Research (ZEF), University of Bonn, Bonn, Germany
| | - Reginald Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - John Nortey
- Statistics, Research, and Information Directorate, Ministry of Food and Agriculture, Accra, Ghana
| | - Nicholas Bricas
- UMR MoISA (Montpellier Interdisciplinary Center on Sustainable Agri-food Systems), CIRAD, University of Montpellier, Montpellier, France
| | | | | | - Ali Jafri
- Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Meenal Dhall
- Department of Anthropology, University of Delhi, Delhi, India
| | - Amanda Lee
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Samuel O Oti
- International Development Research Center, Nairobi, Kenya
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Sciences - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Center on Sustainable Agri-food Systems), University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, French National Research Institute for Sustainable Development (IRD), Montpellier, France
| |
Collapse
|
29
|
Ross A, Swart EC, Frank T, Lowery CM, Ng SW. South Africa's Health Promotion Levy on Pricing and Acquisition of Beverages in Local Spazas and Supermarkets. Public Health Nutr 2022; 25:1-26. [PMID: 35249582 PMCID: PMC9991735 DOI: 10.1017/s1368980022000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/03/2022] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In response to concern over rising sugar-sweetened beverage (SSB) consumption, in April 2018, South Africa became the first Sub-Saharan African country to implement an SSB tax. We assess changes in pricing and acquisition of beverages from local supermarkets and small stores among 18-39 year old adults living in one township in the Western Cape, before and after tax implementation. This study is among the first evaluations of an SSB tax on the local food environment in a low-income township. DESIGN Store beverage pricing and participant surveys were cross-sectional, analyzed 1 month before and 11 months after implementation of the tax (March 2018 and March 2019). SETTING Langa, Western Cape, South Africa. PARTICIPANTS Surveyed participants were residents of Langa between 18-39 years old (N=2,693 in 2018 and N=2,520 in 2019). RESULTS Prices of taxed SSBs increased significantly among small shops and supermarkets between 2018 and 2019. There were non-significant decreases in prices of untaxed beverages in small shops, but prices of untaxed beverages increased in supermarkets. Across all store types, there was a 9 percentage point decrease in the probability of purchasing regular soda weekly pre/post-implementation. Reductions in purchasing were larger in small shops than supermarkets. CONCLUSIONS We found some differential impacts of the levy on pricing and acquisition of beverages by retailer type in one low-income township. As other Sub-Saharan African countries consider similar fiscal policies to curb soda consumption, obesity and related diseases, this work can be used to understand the implications of these policies in the retail setting.
Collapse
Affiliation(s)
- Alexandra Ross
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa
- DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Tamryn Frank
- School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| |
Collapse
|
30
|
Affiliation(s)
- Jennifer Falbe
- Department of Human Ecology, University of California, One
Shields Ave, Davis, CA 95616,Corresponding author: 530-752-9653,
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public
Health
| | | |
Collapse
|
31
|
Valizadeh P, Popkin BM, Ng SW. Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor. Am J Clin Nutr 2022; 115:244-255. [PMID: 34610088 PMCID: PMC8755035 DOI: 10.1093/ajcn/nqab330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/27/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed. OBJECTIVES We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and combinations of SSB taxes with fruit and vegetable (FV) subsidies targeted to low-income households on SSB and FV purchases of lower and higher SSB purchasers. METHODS We considered a 1-cent-per-ounce SSB tax and 2 FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan data. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies' differential effects. RESULTS Higher-SSB-purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 compared with 0.5 oz/day at percentile 25; P < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households, regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate. CONCLUSIONS SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels before policy implementation. Expanding taxes beyond SSBs, providing larger FV subsidies, or offering subsidies beyond FVs, particularly for low-income households with children, may be more effective.
Collapse
Affiliation(s)
- Pourya Valizadeh
- Agricultural & Food Policy Center, Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
- Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
| | - Barry M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
32
|
Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
Collapse
Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
33
|
Adom T, De Villiers A, Puoane T, Kengne AP. A Scoping Review of Policies Related to the Prevention and Control of Overweight and Obesity in Africa. Nutrients 2021; 13:4028. [PMID: 34836281 PMCID: PMC8625107 DOI: 10.3390/nu13114028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022] Open
Abstract
To address the issue of obesity, the World Health Organization (WHO) recommends a set of comprehensive programmes aimed at changing the obesogenic environments to provide opportunities for healthy food options and increased physical activity in the school, home, and at the population level. The objectives of this study were to examine the nature and range of policies related to overweight and obesity prevention in Africa, and to assess how they align with international guidelines. An existing methodological framework was adapted for this scoping review. A search of publicly available national documents on overweight/obesity, general health, and non-communicable diseases (NCDs) was undertaken from relevant websites, including WHO, ministries, and Google Scholar. Additional requests were sent to key contacts at relevant ministries about existing policy documents. The documents were reviewed, and the policies were categorised, using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The framework categorises the environmental drivers of obesity into four domains (physical, economic, legislative, and socio-cultural) and two scales: macro (national, regional, sectors, food industries, media, etc.) and micro (household, institutional, and community). This review included documents from 41 African countries. The policy initiatives to prevent overweight/obesity target the school, family and community settings, and macro environments, and broadly align with global recommendations. The NCD documents were in the majority, with only two on obesity. The majority of the documents detailed strategies and key interventions on unhealthy diets and physical inactivity. The physical, legislative, and sociocultural domains were largely featured, with less emphasis on the economic domain. Additionally, nutrition- and diet-related policies were in the majority. Overlaps and interactions of policies were observed in the application of the ANGELO framework. This study has provided information on national policies and programmes in Africa and can be useful as a first point of call for policymakers. The overlapping and interaction in the initiatives demonstrate the importance of multi-sectoral partnerships in providing supportive environments for healthy behaviours.
Collapse
Affiliation(s)
- Theodosia Adom
- Nutrition Research Centre, Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra LG80, Ghana
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Anniza De Villiers
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.D.V.); (A.P.K.)
| | - Thandi Puoane
- School of Public Health, Faculty of Community and Health Sciences, University of Western Cape, Cape Town 7535, South Africa;
| | - André Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.D.V.); (A.P.K.)
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| |
Collapse
|
34
|
Ng SW, Colchero MA, White M. How should we evaluate sweetened beverage tax policies? A review of worldwide experience. BMC Public Health 2021; 21:1941. [PMID: 34702248 PMCID: PMC8546197 DOI: 10.1186/s12889-021-11984-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/12/2021] [Indexed: 02/02/2023] Open
Abstract
Over 45 jurisdictions globally have implemented sweetened beverage taxes. Researchers and policymakers need to assess whether and how these taxes change beverage demand and supply, their intended and unanticipated health, economic and equity impacts. Lessons from such evaluations can maximise the policies' success and impact on non-communicable disease prevention globally. We discuss key theoretical, design and methodological considerations to help policymakers, funders and researchers commission and conduct rigorous evaluations of these policies and related disease prevention efforts. We encourage involving the perspectives of various stakeholders on what evaluations are needed given the specific context, what data and methods are appropriate, readily available or can be collected within time and budget constraints. A logic model /conceptual system map of anticipated implications across sectors and scales should help identify optimal study design, analytical techniques and measures. These models should be updated when synthesising findings across diverse methods and integrating findings across subpopulations using similar methods.
Collapse
Affiliation(s)
- Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, CB #8120, 137 East Franklin Street, Chapel Hill, NC, 27516, USA.
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7461, UNC-Chapel Hill, Chapel Hill, NC, 27599-7461, USA.
| | - M Arantxa Colchero
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, CP, 62100, Cuernavaca, Morelos, Mexico
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
35
|
Hofman KJ, Stacey N, Swart EC, Popkin BM, Ng SW. South Africa's Health Promotion Levy: Excise tax findings and equity potential. Obes Rev 2021; 22:e13301. [PMID: 34060197 PMCID: PMC8349837 DOI: 10.1111/obr.13301] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/26/2022]
Abstract
In 2016, the South African government proposed a 20% sugar-sweetened beverage (SSB) tax. Protracted consultations with beverage manufacturers and the sugar industry followed. This resulted in a lower sugar-based beverage tax, the Health Promotion Levy (HPL), of approximately 10% coming into effect in April 2018. We provide a synthesis of findings until April 2021. Studies show that despite the lower rate, purchases of unhealthy SSBs and sugar intake consumption from SSBs fell. There were greater reductions in SSB purchases among both lower socioeconomic groups and in subpopulations with higher SSB consumption. These subpopulations bear larger burdens from obesity and related diseases, suggesting that this policy improves health equity. The current COVID-19 pandemic has impacted food and nutritional security. Increased pandemic mortality among people with obesity, diabetes, and hypertension highlight the importance of intersectoral public health disease-prevention policies like the HPL, which should be strengthened.
Collapse
Affiliation(s)
- Karen J Hofman
- SAMRCCentre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Nicholas Stacey
- SAMRCCentre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa.,Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa.,DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
36
|
Salgado Hernández JC, Ng SW. Simulating international tax designs on sugar-sweetened beverages in Mexico. PLoS One 2021; 16:e0253748. [PMID: 34411108 PMCID: PMC8375996 DOI: 10.1371/journal.pone.0253748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/12/2021] [Indexed: 02/07/2023] Open
Abstract
In response to the high prevalence of overweight and obesity, Mexico implemented a volumetric tax of one Mexican peso (MP) per liter of sugar-sweetened beverage (SSB) in 2014. In contrast to Mexico's volumetric tax design, the United Kingdom (UK) and South Africa (ZA) implemented SSB taxes based on sugar density. This kind of tax is likely to yield larger health benefits than volumetric taxes by imposing a larger tax burden on high-sugar SSB and/or encouraging reformulation. However, sugar-density taxes might yield lower tax revenues. This study aims to simulate the effect of sugar-density taxes as those in the UK and ZA on SSB purchases (in terms of volume and sugar), SSB prices, and tax revenue in Mexico and compare this effect to its counterpart under the current volumetric SSB tax. Additionally, we simulate the effect of sugar-density taxes under different scenarios of reformulation. We conducted all these simulations based on a structural model of demand and supply using household purchase data for 2012-2015 in urban Mexico. We found that the current volumetric one-MP tax led to an SSB purchase reduction of 19% for both volume and sugar and an SSB price increases by MP $1.24. We simulated similar effects under the UK and ZA sugar-density taxes when these taxes were equivalent to the volumetric one-MP tax, and there was no reformulation. When assuming reformulation, the sugar reduction under the sugar-density taxes was up to twice larger than the volumetric one-MP tax. However, we found that the volumetric one-MP tax yielded the largest tax revenue across all tax designs. From a public health perspective, sugar-density taxes are likely to be more effective in tackling the overweight and obesity prevalence in Mexico; however, tax revenue might be lower under these taxes.
Collapse
Affiliation(s)
- Juan Carlos Salgado Hernández
- Center for Research in Health Systems, National Institute of Public Health, Cuernavaca, Mexico
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
37
|
Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol 2021; 9:462-470. [PMID: 33865500 PMCID: PMC8217149 DOI: 10.1016/s2213-8587(21)00078-4] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
The global surges in obesity and nutrition-related non-communicable diseases (NCDs) have created a need for decisive new food policy initiatives. A major concern has been the impact of ultra-processed foods (UPFs) and ultra-processed drinks on weight gain and on the risk of several NCDs. These foods, generally high in calories, added sugar, sodium, and unhealthy fats, and poor in fibre, protein, and micronutrients, have extensive negative effects on human health and on the environment (due to their associated carbon emission and water use). There is a growing tendency worldwide, and especially in South America, for food companies to add micronutrients to UPFs to make health claims regarding these products, to which food-regulating authorities refer to fake foods. Although more than 45 countries and smaller subregional or urban entities have created taxes on ultra-processed drinks, such as sugar-sweetened beverages, only a few have adopted taxes on snacks and other UPFs, and none have added major subsidies for truly healthy, fresh or minimally processed food for people from lower socioeconomic backgrounds. Another major focus has been on developing effective package labelling. A smaller number of countries have selected the most impactful warning labels and linked them with other measures to create a mutually reinforcing set of policies; a few other countries have developed effective school food policies. We herein present in-depth results from key countries involved in all these actions and in comprehensive marketing controls, and conclude with our recommendations for the future. This field is quite new; progress to date is substantial, but much more is left to learn.
Collapse
Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Simon Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karen J Hofman
- South African Medical Research Council Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Carlos Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth C Swart
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
38
|
Taxed and untaxed beverage intake by South African young adults after a national sugar-sweetened beverage tax: A before-and-after study. PLoS Med 2021; 18:e1003574. [PMID: 34032809 PMCID: PMC8148332 DOI: 10.1371/journal.pmed.1003574] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In an effort to prevent and reduce the prevalence rate of people with obesity and diabetes, South Africa implemented a sugar-content-based tax called the Health Promotion Levy in April 2018, one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100 ml). This before-and-after study estimated changes in taxed and untaxed beverage intake 1 year after the tax, examining separately, to our knowledge for the first time, the role of reformulation distinct from behavioral changes in SSB intake. METHODS AND FINDINGS We collected single-day 24-hour dietary recalls from repeat cross-sectional surveys of adults aged 18-39 years in Langa, South Africa. Participants were recruited in February-March 2018 (pre-tax, n = 2,459) and February-March 2019 (post-tax, n = 2,489) using door-to-door sampling. We developed time-specific food composition tables (FCTs) for South African beverages before and after the tax, linked with the diet recalls. By linking pre-tax FCTs only to dietary intake data collected in the pre-tax and post-tax periods, we calculated changes in beverage intake due to behavioral change, assuming no reformulation. Next, we repeated the analysis using an updated FCT in the post-tax period to capture the marginal effect of reformulation. We estimated beverage intake using a 2-part model that takes into consideration the biases in using ordinary least squares or other continuous variable approaches with many individuals with zero intake. First, a probit model was used to estimate the probability of consuming the specific beverage category. Then, conditional on a positive outcome, a generalized linear model with a log-link was used to estimate the continuous amount of beverage consumed. Among taxed beverages, sugar intake decreased significantly (p < 0.0001) from 28.8 g/capita/day (95% CI 27.3-30.4) pre-tax to 19.8 (95% CI 18.5-21.1) post-tax. Energy intake decreased (p < 0.0001) from 121 kcal/capita/day (95% CI 114-127) pre-tax to 82 (95% CI 76-87) post-tax. Volume intake decreased (p < 0.0001) from 315 ml/capita/day (95% CI 297-332) pre-tax to 198 (95% CI 185-211) post-tax. Among untaxed beverages, sugar intake increased (p < 0.0001) by 5.3 g/capita/day (95% CI 3.7 to 6.9), and energy intake increased (p < 0.0001) by 29 kcal/capita/day (95% CI 19 to 39). Among total beverages, sugar intake decreased significantly (p = 0.004) by 3.7 (95% CI -6.2 to -1.2) g/capita/day. Behavioral change accounted for reductions of 24% in energy, 22% in sugar, and 23% in volume, while reformulation accounted for additional reductions of 8% in energy, 9% in sugar, and 14% in volume from taxed beverages. The key limitations of this study are an inability to make causal claims due to repeat cross-sectional data collection, and that the magnitude of reduction in taxed beverage intake may not be generalizable to higher income populations. CONCLUSIONS Using a large sample of a high-consuming, low-income population, we found large reductions in taxed beverage intake, separating the components of behavioral change from reformulation. This reduction was partially compensated by an increase in sugar and energy from untaxed beverages. Because policies such as taxes can incentivize reformulation, our use of an up-to-date FCT that reflects a rapidly changing food supply is novel and important for evaluating policy effects on intake.
Collapse
|