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Sarhan MM, Aljohani SA, Alnazzawi YA, Alharbi NA, Alotaibi SE, Alhujaili AS, Alwadi MAM. Individuals' perceptions of the factors linked to everyday soft drink consumption among university students: qualitative study. Front Nutr 2024; 11:1388918. [PMID: 39224179 PMCID: PMC11366578 DOI: 10.3389/fnut.2024.1388918] [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: 02/21/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
Background Soft drink consumption is continuing to grow worldwide, posing an increasing threat to people's health and general wellbeing. Consequently, we must understand the factors driving soft drink consumption to support improvements to nutrition. This paper adopts a qualitative research approach to explore individuals' perceptions of the factors linked to daily soft drink consumption among university students in Saudi Arabia. Materials and methods This research employed purposive sampling to recruit a total of 19 students attending university in Al Madinah Province, Saudi Arabia, all of whom reported that they had previously consumed soft drinks. Over 3 months, data was gathered through a mixture of online and in-person semi-structured interviews. Once completed, the interviews were then transcribed and analyzed using inductive thematic analysis to identify the themes that emerged from the data. Results This study reveals five core themes: taste, habit, price, environment and social context, and health concerns. Regarding health concerns, this study finds that the public's increasing concerns about health can reduce people's consumption of soft drinks. Significantly, this research reveals that the rise in health concerns among the public is being driven by the growing conversation about healthy food and the negative impact of consuming sugary soft drinks occurring in wider society. Conclusion To conclude, this research underlines the value of adopting a holistic approach to promoting healthier drink choices (and thus reducing soft drink consumption). Interventions that focus on factors associated with soft drink consumption, such as habits, price, environment, social settings, health concerns, and taste, will be better able to decrease soft drink consumption and improve people's nutritional intake.
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Affiliation(s)
- Mohammed Mahmoud Sarhan
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Shemaa Adel Aljohani
- College of Dentistry and Hospital, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Yara Ahmad Alnazzawi
- College of Dentistry and Hospital, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Nuorah Awadh Alharbi
- College of Dentistry and Hospital, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Shihanah Eid Alotaibi
- College of Dentistry and Hospital, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Ahmed Saad Alhujaili
- College of Dentistry and Hospital, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Maram Ali M. Alwadi
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Thiboonboon K, Lourenco RDA, Cronin P, Khoo T, Goodall S. Economic Evaluations of Obesity-Targeted Sugar-Sweetened Beverage (SSB) Taxes-A Review to Identify Methodological Issues. Health Policy 2024; 144:105076. [PMID: 38692186 DOI: 10.1016/j.healthpol.2024.105076] [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: 06/25/2023] [Revised: 04/06/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Economic evaluations of public health interventions like sugar-sweetened beverage (SSB) taxes face difficulties similar to those previously identified in other public health areas. This stems from challenges in accurately attributing effects, capturing outcomes and costs beyond health, and integrating equity effects. This review examines how these challenges were addressed in economic evaluations of SSB taxes. METHODS A systematic review was conducted to identify economic evaluations of SSB taxes focused on addressing obesity in adults, published up to February 2021. The methodological challenges examined include measuring effects, valuing outcomes, assessing costs, and incorporating equity. RESULTS Fourteen economic evaluations of SSB taxes were identified. Across these evaluations, estimating SSB tax effects was uncertain due to a reliance on indirect evidence that was less robust than evidence from randomised controlled trials. Health outcomes, like quality-adjusted life years, along with a healthcare system perspective for costs, dominated the evaluations of SSB taxes, with a limited focus on broader non-health consequences. Equity analyses were common but employed significantly different approaches and exhibited varying degrees of quality. CONCLUSION Addressing the methodological challenges remains an issue for economic evaluations of public health interventions like SSB taxes, suggesting the need for increased attention on those issues in future studies. Dedicated methodological guidelines, in particular addressing the measurement of effect and incorporation of equity impacts, are warranted.
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Affiliation(s)
- Kittiphong Thiboonboon
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Paula Cronin
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Terence Khoo
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
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Smith BT, Warren CM, Anderson LN, Hammond D, Manuel DG, Li Y, Andreacchi AT, Rosella LC, Fu SH, Hobin E. The equitable impact of sugary drink taxation structures on sugary drink consumption among Canadians: a modelling study using the 2015 Canadian Community Health Survey-Nutrition. Public Health Nutr 2024; 27:e121. [PMID: 38618932 PMCID: PMC11075107 DOI: 10.1017/s1368980024000545] [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: 05/25/2023] [Revised: 11/09/2023] [Accepted: 02/12/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Estimate the impact of 20 % flat-rate and tiered sugary drink tax structures on the consumption of sugary drinks, sugar-sweetened beverages and 100 % juice by age, sex and socio-economic position. DESIGN We modelled the impact of price changes - for each tax structure - on the demand for sugary drinks by applying own- and cross-price elasticities to self-report sugary drink consumption measured using single-day 24-h dietary recalls from the cross-sectional, nationally representative 2015 Canadian Community Health Survey-Nutrition. For both 20 % flat-rate and tiered sugary drink tax scenarios, we used linear regression to estimate differences in mean energy intake and proportion of energy intake from sugary drinks by age, sex, education, food security and income. SETTING Canada. PARTICIPANTS 19 742 respondents aged 2 and over. RESULTS In the 20 % flat-rate scenario, we estimated mean energy intake and proportion of daily energy intake from sugary drinks on a given day would be reduced by 29 kcal/d (95 % UI: 18, 41) and 1·3 % (95 % UI: 0·8, 1·8), respectively. Similarly, in the tiered tax scenario, additional small, but meaningful reductions were estimated in mean energy intake (40 kcal/d, 95 % UI: 24, 55) and proportion of daily energy intake (1·8 %, 95 % UI: 1·1, 2·5). Both tax structures reduced, but did not eliminate, inequities in mean energy intake from sugary drinks despite larger consumption reductions in children/adolescents, males and individuals with lower education, food security and income. CONCLUSIONS Sugary drink taxation, including the additional benefit of taxing 100 % juice, could reduce overall and inequities in mean energy intake from sugary drinks in Canada.
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Affiliation(s)
- Brendan T Smith
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
| | - Christine M Warren
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON,
Canada
- Child Health Evaluative Sciences, Sickkids Research
Institute, Toronto, ON,
Canada
| | - David Hammond
- School of Public Health Sciences, University of
Waterloo, Waterloo, ON,
Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Clinical Epidemiology, 501
Smyth Box 511, Ottawa, ON, Canada
- Department of Family Medicine, and School of Epidemiology and Public
Health, University of Ottawa, Ottawa,
ON, Canada
- Bruyère Research Institute, OttawaON, Canada
| | - Ye Li
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
| | - Alessandra T Andreacchi
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
- Institute for Better Health, Trillium Health Partners,
MississaugaON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of
Medicine, University of Toronto, Toronto,
ON, Canada
| | - Sze Hang Fu
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
| | - Erin Hobin
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
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Peñalvo JL. The impact of taxing sugar-sweetened beverages on diabetes: a critical review. Diabetologia 2024; 67:420-429. [PMID: 38177563 DOI: 10.1007/s00125-023-06064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024]
Abstract
The global burden of type 2 diabetes is increasing at an alarming rate, fuelled by the obesity epidemic, with significant associated health and economic consequences and apparent inequalities. Sugar-sweetened beverages (SSBs) are a major source of added sugars in diets worldwide and have been linked to an increased risk of type 2 diabetes through a variety of mechanisms, including excess weight. Taxing SSBs has become a promising public health strategy to reduce consumption and mitigate the burden of type 2 diabetes. A substantial body of evidence suggests that SSB taxes lead to increased prices and subsequent reduced consumption, with a potentially greater effect among lower socioeconomic groups. This highlights the potential for tax policies to have an impact on type 2 diabetes and address health inequalities. Evidence from several ongoing SSB tax schemes, including sales and excise taxes, indicates positive effects on improving consumption patterns, and modelling studies point to health gains by averting type 2 diabetes and other cardiometabolic diseases. In contrast, evidence from empirical evaluation of the impact of SSB tax is scarce. Continued monitoring and the strengthening of evaluation research to develop context-tailored policies are required. In addition, there is a need to implement complementary efforts to amplify the impact of SSB taxation and effectively address the global burden of type 2 diabetes.
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Affiliation(s)
- José L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium.
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Colombet Z, Robinson E, Kypridemos C, Jones A, O'Flaherty M. Effect of calorie labelling in the out-of-home food sector on adult obesity prevalence, cardiovascular mortality, and social inequalities in England: a modelling study. Lancet Public Health 2024; 9:e178-e185. [PMID: 38429017 DOI: 10.1016/s2468-2667(23)00326-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND England implemented a menu calorie labelling policy in large, out-of-home food businesses in 2022. We aimed to model the likely policy impact on population-level obesity and cardiovascular disease mortality, as well as the socioeconomic equity of estimated effects, in the adult population in England. METHODS For this modelling analysis, we built a comparative assessment model using two scenarios: the current implementation scenario refers to actual deployment only in large (≥250 employees), out-of-home food businesses, whereas the full implementation scenario refers to deployment in every out-of-home food business. We compared each scenario with a counterfactual: the scenario in which no intervention is implemented (ie, baseline). For both scenarios, we modelled the impact of the policy through assumed changes in energy intake due to either consumer response or product reformulation by retailers. We used data from the Office for National Statistics and the National Diet and Nutrition Survey 2009-19, and modelled the effect over 20 years (ie, 2022-41) to capture the long-term impact of the policy and provided mid-period results after 10 years. We used the Monte Carlo approach (2500 iterations) to estimate the uncertainty of model parameters. For each scenario, the model generated the change in obesity prevalence and the total number of deaths prevented or postponed. FINDINGS The current implementation scenario was estimated to reduce obesity prevalence by 0·31 percentage points (absolute; 95% uncertainty interval [UI] 0·10-0·35), which would prevent or postpone 730 cardiovascular disease deaths (UI 430-1300) of the 830 000 deaths (UI 600 000-1 200 000) expected over 20 years. However, the health benefits would be increased if calorie labelling was implemented in all out-of-home food businesses (2·65 percentage points reduction in obesity prevalence [UI 1·97-3·24] and 9200 cardiovascular disease deaths prevented or postponed [UI 5500-16 000]). Results were similar in the most and the least deprived socioeconomic groups. INTERPRETATION This study offers the first modelled estimation of the impact of the menu calorie labelling regulation on the adult population in England, although we did not include a cost-effectiveness analysis. Calorie labelling might result in a reduction in obesity prevalence and cardiovascular disease mortality without widening health inequalities. However, our results emphasise the need for the government to be more ambitious by applying this policy to all out-of-home food businesses to maximise impact. FUNDING European Research Council.
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Affiliation(s)
- Zoé Colombet
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Cobiac LJ, Rogers NT, Adams J, Cummins S, Smith R, Mytton O, White M, Scarborough P. Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling study. PLoS Med 2024; 21:e1004371. [PMID: 38547319 PMCID: PMC11008889 DOI: 10.1371/journal.pmed.1004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/11/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The soft drinks industry levy (SDIL) in the United Kingdom has led to a significant reduction in household purchasing of sugar in drinks. In this study, we examined the potential medium- and long-term implications for health and health inequalities among children and adolescents in England. METHODS AND FINDINGS We conducted a controlled interrupted time series analysis to measure the effects of the SDIL on the amount of sugar per household per week from soft drinks purchased, 19 months post implementation and by index of multiple deprivation (IMD) quintile in England. We modelled the effect of observed sugar reduction on body mass index (BMI), dental caries, and quality-adjusted life years (QALYs) in children and adolescents (0 to 17 years) by IMD quintile over the first 10 years following announcement (March 2016) and implementation (April 2018) of the SDIL. Using a lifetable model, we simulated the potential long-term impact of these changes on life expectancy for the current birth cohort and, using regression models with results from the IMD-specific lifetable models, we calculated the impact of the SDIL on the slope index of inequality (SII) in life expectancy. The SDIL was found to have reduced sugar from purchased drinks in England by 15 g/household/week (95% confidence interval: -10.3 to -19.7). The model predicts these reductions in sugar will lead to 3,600 (95% uncertainty interval: 946 to 6,330) fewer dental caries and 64,100 (54,400 to 73,400) fewer children and adolescents classified as overweight or obese, in the first 10 years after implementation. The changes in sugar purchasing and predicted impacts on health are largest for children and adolescents in the most deprived areas (Q1: 11,000 QALYs [8,370 to 14,100] and Q2: 7,760 QALYs [5,730 to 9,970]), while children and adolescents in less deprived areas will likely experience much smaller simulated effects (Q3: -1,830 QALYs [-3,260 to -501], Q4: 652 QALYs [-336 to 1,680], Q5: 1,860 QALYs [929 to 2,890]). If the simulated effects of the SDIL are sustained over the life course, it is predicted there will be a small but significant reduction in slope index of inequality: 0.76% (95% uncertainty interval: -0.9 to -0.62) for females and 0.94% (-1.1 to -0.76) for males. CONCLUSIONS We predict that the SDIL will lead to medium-term reductions in dental caries and overweight/obesity, and long-term improvements in life expectancy, with the greatest benefits projected for children and adolescents from more deprived areas. This study provides evidence that the SDIL could narrow health inequalities for children and adolescents in England.
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Affiliation(s)
- Linda J. Cobiac
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Nina T. Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Smith
- Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Oliver Mytton
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK & NIHR Oxford Health Biomedical Research Centre at Oxford, Oxford, United Kingdom
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7
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Kim DD. The role of simulation modelling in public health policy evaluation. Lancet Public Health 2024; 9:e150-e151. [PMID: 38429013 PMCID: PMC11309631 DOI: 10.1016/s2468-2667(24)00027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Affiliation(s)
- David D Kim
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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8
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Chegere MJ, Jires T, Fortunata S, Emmanuel M, Twalib N, Mary M, Jovin L. The Potential Effect of Sugar-Sweetened Beverages Tax on Obesity Prevalence in Tanzania. East Afr Health Res J 2023; 7:289-301. [PMID: 39219654 PMCID: PMC11364192 DOI: 10.24248/eahrj.v7i2.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/03/2023] [Indexed: 09/04/2024] Open
Abstract
Background Obesity and the associated non-communicable diseases contribute significantly to the disease burden in Tanzania. Obesity can be attributed to the consumption of Sugar Sweetened Beverages (SSB) due to their high sugar content that leads to high caloric intakes. This study estimates the effect of SSB tax on the prevalence of obesity. Methods A mathematical model that compares the reference population which is unchanged and a counterfactual population in which tax intervention has been introduced is developed. Changes in price and consumption of SSBs, and subsequent changes in energy intake are applied to estimate the body mass change by age groups. The change in body mass by age groups is merged with the reference population to estimate changes in body mass index and obesity. Results Imposing a 20% SSB tax in Tanzania is estimated to reduce the average overall energy intake by 76.1 kJ per person per day. This change is associated with an overall reduction of prevalence of obesity by 6.6%; and by 12.9% and 5.2% in adult males and adult females, respectively. The number of obese people will potentially decrease by about 47,000 among adult males and about 85,000 among adult females from the current levels. Conclusions The SSB tax is a potential strategy to complement efforts to reduce obesity prevalence in Tanzania. The revenue generated from the tax should be channelled towards public health promotion programs.
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Affiliation(s)
| | | | | | | | - Ngoma Twalib
- Muhimbili University of Health and Allied Sciences
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9
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Phulkerd S, Thongcharoenchupong N, Dickie S, Machado P, Woods J, Mo-Suwan L, Prasertsom P, Ungchusak C, Khitdee C, Lawrence M. Profiling ultra-processed foods in Thailand: sales trend, consumer expenditure and nutritional quality. Global Health 2023; 19:64. [PMID: 37653543 PMCID: PMC10472697 DOI: 10.1186/s12992-023-00966-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Ultra-processed foods (UPF) are associated with adverse health outcomes. This study aimed to analyse the national trends in retail sales, consumer expenditure and nutritional quality of UPFs in Thailand. METHODS The study used data from the Euromonitor Passport database for analysis of retail sales and consumer expenditure, and from the Mintel Global New Products Database for nutritional analysis using the WHO Southeast Asian Region nutrient profile model. RESULTS The study found the highest per capita sales volume and value of UPFs in 2021 were sauces, dressings & condiments (8.4 kg/capita) and carbonated soft drinks (27.1 L/capita), respectively. However, functional & flavoured water, ready-made meals and baked goods had the highest observed (2012-2021) and expected (2021-2026) sales growth. Supermarkets were responsible for most of the UPF sales since 2012, but convenience stores had larger growth in retail values. Growth in consumer expenditure per capita on UPFs from 2012 to 2020, ranged between 12.7% and 34%, and till 2026 is forecast to grow between 26% and 30%. More than half of UPFs exceeded at least one nutrient cutoff, 59.3% for total fats, 24.8% for saturated fats, 68.2% for total sugars and 94.3% for sodium. CONCLUSIONS The findings suggest a need for regulatory and non-regulatory measures such as UPF taxation and marketing restrictions, and market incentives for producing non-UPFs. A system for regularly monitoring and evaluating healthiness (both nutritional and processing aspects) of food products, especially UPFs, is required.
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Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Phutthamonthon, Nakhon Pathom, Thailand.
| | | | - Sarah Dickie
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Priscila Machado
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Julie Woods
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Ladda Mo-Suwan
- Department of Paediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Piyada Prasertsom
- Sweet Enough Network, The Foundation of Oral Health, Mueang, Nonthaburi, Thailand
| | - Chantana Ungchusak
- Healthy Food Plan, Thai Health Promotion Foundation, Sathorn, Bangkok, Thailand
| | - Chiraporn Khitdee
- Department of Health, Bureau of Dental Health, Ministry of Public Health, Mueang, Nonthaburi, Thailand
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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10
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Tuson M, Harper P, Gartner D, Behrens D. Understanding the Impact of Social Networks on the Spread of Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6451. [PMID: 37568992 PMCID: PMC10419305 DOI: 10.3390/ijerph20156451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023]
Abstract
Previous research has highlighted the significant role social networks play in the spread of non-communicable chronic diseases. In our research, we seek to explore the impact of these networks in more detail and gain insight into the mechanisms that drive this. We use obesity as a case study. To achieve this, we develop a generalisable hybrid simulation and optimisation approach aimed at gaining qualitative and quantitative insights into the effect of social networks on the spread of obesity. Our simulation model has two components. Firstly, an agent-based component mimics the dynamic structure of the social network within which individuals are situated. Secondly, a system dynamics component replicates the relevant behaviours of those individuals. The parameters from the combined model are refined and optimised using longitudinal data from the United Kingdom. The simulation produces projections of Body Mass Index broken down by different age groups and gender over a 10-year period. These projections are used to explore a range of scenarios in a computational study designed to address our research aims. The study reveals that, for the youngest population sub-groups, the network acts to magnify the impact of external and social factors on changes in obesity, whereas, for older sub-groups, the network mitigates the impact of these factors. The magnitude of that impact is inversely correlated with age. Our approach can be used by public health decision makers as well as managers in adult weight management services to enhance initiatives and strategies intended to reduce obesity. Our approach is generalisable to understand the impact of social networks on similar non-communicable diseases.
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Affiliation(s)
- Mark Tuson
- School of Mathematics, Cardiff University, Cardiff CF24 4AG, UK; (P.H.)
| | - Paul Harper
- School of Mathematics, Cardiff University, Cardiff CF24 4AG, UK; (P.H.)
| | - Daniel Gartner
- School of Mathematics, Cardiff University, Cardiff CF24 4AG, UK; (P.H.)
- Aneurin Bevan Continuous Improvement, Aneurin Bevan University Health Board, Caerleon NP18 3XQ, UK
| | - Doris Behrens
- Employee Wellbeing Service, Aneurin Bevan University Health Board, Cwmbran NP44 8YN, UK
- Department of Economy and Health, University of Continuing Education Krems, 3500 Krems an der Donau, Austria;
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11
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Dumith SC, Martins OPL, Moreira MKV, Paulitsch RG, Simões MO, Marmitt LP, Silva PEA, Silva MP. Is the increment of diabetes mellitus in Brazil associated with the consumption of artificially sweetened beverages? A time trend analysis with 757,386 adults from 2006 to 2020. Public Health 2023; 221:66-72. [PMID: 37421755 DOI: 10.1016/j.puhe.2023.06.004] [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: 02/15/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To describe trends in the prevalence of diabetes mellitus (DM) in Brazil and to analyze its association with the consumption of artificially sweetened beverages among individuals aged 18 years or older. STUDY DESIGN This was a repeated cross-sectional study. METHODS Annual data from VIGITEL surveys (2006-2020) were used, which included adults from all Brazilian state capitals. The outcome was the prevalence of DM (type 1 and type 2). The main exposure variable was consuming beverages like soft drinks and artificial juices, either in its 'diet, light, or zero' form. Covariates included sex, age, sociodemographic characteristics, smoking, alcohol consumption, physical activity, fruit consumption, and obesity. The temporal trend in the indicators and the etiological fraction (population attributable risk [PAR]) were calculated. Analyses were performed using Poisson regression. The association between DM and consumption of beverages was tested, excluding the year 2020 due to the pandemic; restricting the analysis to the final three years (2018-2020). RESULTS Overall, 757,386 subjects were included. The prevalence of DM increased from 5.5% to 8.2%, with an annual growth of 0.17 percentage points (95% CI 0.11-0.24). Among those who consumed diet/light/zero beverages, the annual percentage change of DM was four times greater. The PAR corresponding to the consumption of diet/light/zero beverages on the occurrence of DM was 17%. CONCLUSIONS An increasing prevalence of DM was observed, while diet/light/zero beverages consumption remains stable. A substantial reduction in the annual percentage change of DM could be observed if people stopped consuming diet/light soda/juice.
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Affiliation(s)
- S C Dumith
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - O P L Martins
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - M K V Moreira
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, CEP: 96020-220, Brazil
| | - R G Paulitsch
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Empresa Brasileira de Serviços Hospitalares, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - M O Simões
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Universidade Vale do Rio Doce, Governador Valadares, MG, CEP: 35020-220, Brazil
| | - L P Marmitt
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Postgraduate Program in Biosciences and Health, Universidade do Oeste de Santa Catarina, Joaçaba, SC, CEP: 89600-000, Brazil.
| | - P E A Silva
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil
| | - M P Silva
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
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12
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Walton J, Bell H, Re R, Nugent AP. Current perspectives on global sugar consumption: definitions, recommendations, population intakes, challenges and future direction. Nutr Res Rev 2023; 36:1-22. [PMID: 34369326 DOI: 10.1017/s095442242100024x] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Currently, there is considerable emphasis on the relationship between dietary sugar consumption and various health outcomes, with some countries and regions implementing national sugar reduction campaigns. This has resulted in significant efforts to quantify dietary sugar intakes, to agree on terms to describe dietary sugars and to establish associated recommendations. However, this information is infrequently collated on a global basis and in a regularised manner. The present review provides context regarding sugar definitions and recommendations. It provides a global review of the available data regarding dietary sugar intake, considering forms such as total, free and added sugars. A comprehensive breakdown of intakes is provided by age group, country and sugar form. This analysis shows that free sugar intakes as a percentage of total energy (%E) are the highest for children and adolescents (12-14%E) and the lowest for older adults (8%E). This trend across lifecycle stages has also been observed for added sugars. The available data also suggest that, while some reductions in sugar intake are observed in a few individual studies, overall intakes of free/added sugars remain above recommendations. However, any wider conclusions are hampered by a lack of detailed high-quality data on sugar intake, especially in developing countries. Furthermore, there is a need for harmonisation of terms describing sugars (ideally driven by public health objectives) and for collaborative efforts to ensure that the most up-to-date food composition data are used to underpin recommendations and any estimates of intake or modelling scenarios.
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Affiliation(s)
- Janette Walton
- Department of Biological Sciences, Munster Technological University, Cork, Republic of Ireland
| | | | | | - Anne P Nugent
- Institute for Global Food Security, School of Biological Sciences, Queens University Belfast, Belfast, Northern Ireland
- Institute of Food and Health, School of Agriculture and Food Sciences, University College Dublin, Belfield, Dublin 4, Ireland
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Hajishafiee M, Kapellas K, Listl S, Pattamatta M, Gkekas A, Moynihan P. Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: an umbrella review of a global perspective. BMC Public Health 2023; 23:986. [PMID: 37237341 DOI: 10.1186/s12889-023-15884-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND As part of the Global Strategy on Oral health, the World Health Organization (WHO) is exploring cost-effective interventions for oral health, including taxation on sugar-sweetened beverages (SSBs). To inform this process, this umbrella review aimed to identify the best available estimates pertaining to the impact of SSB taxation on the reduction of sugars intake, and the sugars-caries dose-response, such that estimates of the impact of SSB taxation on averting dental caries in both high (HIC) and low and middle (LMIC) countries be available. METHODS The questions addressed were: (1) what are the effects of SSB taxation on consumption of SSBs and (2) sugars? (3) What is the effect on caries of decreasing sugars? and (4) what is the likely impact of a 20% volumetric SSB tax on the number of active caries prevented over 10 years? Data sources included PubMed, Embase, Web of Science, Scopus, CINAHL, Dentistry and Oral Sciences Source, Cochrane Library, Joanna Briggs Institute (JBI) Systematic Review Register, and PROSPERO. The review was conducted with reference to JBI guidelines. The quality of included systematic reviews was assessed using AMSTAR to identify best evidence. RESULTS From 419 systematic reviews identified for questions 1 & 2, and 103 for question 3, 48 (Questions 1 & 2) and 21 (Question 3) underwent full text screening, yielding 14 and five included reviews respectively. Best available data indicated a 10% tax would reduce SSB intake by 10.0% (95% CI: -5.0, 14.7%) in HIC and by 9% (range -6.0 to 12.0%) in LMIC, and that a 20% tax would reduce free sugars intake on average by 4.0 g/d in LMIC and 4.4 g/d in HIC. Based on best available dose response data, this could reduce the number of teeth with caries per adults (HIC and LMIC) by 0.03 and caries occurrence in children by 2.7% (LMIC) and 2.9% (HIC), over a 10-year period. CONCLUSION Best available data suggest a 20% volumetric SSB tax would have a modest impact on prevalence and severity of dental caries in both HIC and LMIC.
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Affiliation(s)
| | - Kostas Kapellas
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Madhuri Pattamatta
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Athanasios Gkekas
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Paula Moynihan
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
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14
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Flexner N, Ng AP, Ahmed M, Khandpur N, Acton RB, Lee JJ, L’Abbe MR. Estimating the dietary and health impact of implementing front-of-pack nutrition labeling in Canada: A macrosimulation modeling study. Front Nutr 2023; 10:1098231. [PMID: 37006927 PMCID: PMC10065472 DOI: 10.3389/fnut.2023.1098231] [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: 11/14/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Background Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy diets. Health Canada has recently published FOPL regulations that will require food and beverages that meet or exceed set thresholds for sodium, sugars, or saturated fat to display a 'high in' symbol on the front of the package. Although a promising measure, its potential impact on dietary intakes and health have not yet been estimated in Canada. Objective This study aims to estimate (1) the potential dietary impact of implementing a mandatory FOPL among Canadian adults; and (2) the number of diet-related non-communicable disease (NCD) deaths that could be averted or delayed due to these estimated dietary changes. Methods Baseline and counterfactual usual intakes of sodium, total sugars, saturated fats, and calories were estimated among Canadian adults (n = 11,992) using both available days of 24 h recalls from the 2015 Canadian Community Health Survey-Nutrition. The National Cancer Institute method was used to estimate usual intakes, and adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall. Estimated counterfactual dietary intakes were modeled from reductions observed in experimental and observational studies that examined changes in sodium, sugars, saturated fat, and calorie content of food purchases in the presence of a 'high in' FOPL (four counterfactual scenarios). The Preventable Risk Integrated ModEl was used to estimate potential health impacts. Results Estimated mean dietary reductions were between 31 and 212 mg/day of sodium, 2.3 and 8.7 g/day of total sugars, 0.8 and 3.7 g/day of saturated fats, and 16 and 59 kcal/day of calories. Between 2,183 (95% UI 2,008-2,361) and 8,907 (95% UI 8,095-9,667) deaths due to diet-related NCDs, mostly from cardiovascular diseases (~70%), could potentially be averted or delayed by implementing a 'high in' FOPL in Canada. This estimation represents between 2.4 and 9.6% of the total number of diet-related NCD deaths in Canada. Conclusion Results suggest that implementing a FOPL could significantly reduce sodium, total sugar, and saturated fat intakes among Canadian adults and subsequently prevent or postpone a substantial number of diet-related NCD deaths in Canada. These results provide critical evidence to inform policy decisions related to implementing FOPL in Canada.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alena P. Ng
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neha Khandpur
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Center for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Rachel B. Acton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mary R. L’Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Chatelan A, Rouche M, Kelly C, Fismen AS, Pedroni C, Desbouys L, Castetbon K. Tax on sugary drinks and trends in daily soda consumption by family affluence: an international repeated cross-sectional survey among European adolescents. Am J Clin Nutr 2023; 117:576-585. [PMID: 36775689 DOI: 10.1016/j.ajcnut.2023.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The WHO recommends soda taxes to reduce sugar consumption, but the effect across socioeconomic groups is unclear. OBJECTIVES We assessed 16-y trends in daily soda consumption among adolescents in 4 European countries with a soda tax and 5 comparison countries, by family affluence. METHODS Five rounds of the international "Health Behaviour in School-Aged Children" school-based survey were used (school years 2001/2002 to 2017/2018, repeated cross-sectional design). Finland, France, Belgium, and Portugal introduced or updated a soda tax during this period. For comparison, we selected 5 neighboring countries without such a tax. Nationally representative samples of adolescents aged 13 and 15 y (n = 165,521; 51.2% girls) completed a standardized questionnaire, including a question on soda consumption frequency. Using the family affluence scale (FAS), we categorized adolescents into lower-, middle- or higher-affluent groups. Changes in daily soda consumption were assessed in each country independently. RESULTS Before taxation, daily soda consumption was more likely among lower-affluent adolescents in France and Belgium (P < 0.001, socioeconomic inequalities) and was similar across FAS groups in Finland and Portugal (no inequalities). After the tax, daily soda consumption was reduced across all FAS groups in Finland, Belgium, and Portugal (Pinteractions ≥ 0.33). In France, a posttax decrease was observed only among lower-affluent adolescents (ORlower, 0.76; 95% CI: 0.60, 0.96; reduced inequalities). During the same periods, socioeconomic patterns remained stable in 3 comparison countries (Pinteractions ≥ 0.38), and larger reductions in daily soda consumption were observed among middle- or higher-affluent adolescents compared with lower-affluent adolescents in the remaining 2 comparison countries (Pinteractions ≤ 0.08, increased inequalities). CONCLUSIONS Socioeconomic patterns did not change after the tax implementation in 3 out of 4 countries, and socioeconomic inequalities were reduced in France. Taxing sodas might be an effective measure to attenuate, or at least not exacerbate, socioeconomic inequalities in adolescent daily soda consumption. Am J Clin Nutr 20XX;xx:xx-xx.
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Affiliation(s)
- Angeline Chatelan
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium; Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.
| | - Manon Rouche
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Anne-Siri Fismen
- Department of Health Promotion and Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Camille Pedroni
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Lucille Desbouys
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Katia Castetbon
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
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16
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Flexner N, Christoforou AK, Bernstein JT, Ng AP, Yang Y, Fernandes Nilson EA, Labonté MÈ, L'Abbe MR. Estimating Canadian sodium intakes and the health impact of meeting national and WHO recommended sodium intake levels: A macrosimulation modelling study. PLoS One 2023; 18:e0284733. [PMID: 37163471 PMCID: PMC10171671 DOI: 10.1371/journal.pone.0284733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/09/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the second leading cause of total deaths in Canada. High blood pressure is the main metabolic risk factor for developing CVDs. It has been well established that excess consumption of sodium adversely affects blood pressure. Canadians' mean sodium intakes are well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention, however, dietary sodium intake and the potential health impact of meeting recommended sodium intake levels due to food reformulation have not been determined in Canada. OBJECTIVE This study aimed to 1) obtain robust estimates of Canadians' usual sodium intakes, 2) model sodium intakes had foods been reformulated to align with Health Canada's sodium reduction targets, and 3) estimate the number of CVD deaths that could be averted or delayed if Canadian adults were to reduce their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d-driven by a reduction of sodium levels in packaged foods to meet Health Canada targets (reformulation); B) 2,000 mg/d to meet the World Health Organization (WHO) recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation. METHODS Foods in the University of Toronto's Food Label Information Program 2017, a Canadian branded food composition database, were linked to nationally representative food intake data from the 2015 Canadian Community Health Survey-Nutrition to estimate sodium intakes (and intakes had Health Canada's reformulation strategy been fully implemented). The Preventable Risk Integrated ModEl (PRIME) was used to estimate potential health impact. RESULTS Overall, mean sodium intake was 2758 mg/day, varying by age and sex group. Based on 'reformulation' scenario A, mean sodium intakes were reduced by 459 mg/day, to 2299 mg/day. Reducing Canadians' sodium intake to recommended levels under scenarios A, B and C could have averted or delayed 2,176 (95% UI 869-3,687), 3,252 (95% UI 1,380-5,321), and 5,296 (95% UI 2,190-8,311) deaths due to CVDs, respectively, mainly from ischaemic heart disease, stroke, and hypertensive disease. This represents 3.7%, 5.6%, and 9.1%, respectively, of the total number of CVDs deaths observed in Canada in 2019. CONCLUSION Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada's voluntary benchmark sodium reduction targets.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Jodi T Bernstein
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alena P Ng
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yahan Yang
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo A Fernandes Nilson
- Center for Epidemiological Research on Health and Nutrition, University of São Paulo, São Paulo, State of São Paulo, Brazil
| | - Marie-Ève Labonté
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec, Canada
| | - Mary R L'Abbe
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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The Potential Impact of Different Taxation Scenarios towards Sugar-Sweetened Beverages on Overweight and Obesity in Brazil: A Modeling Study. Nutrients 2022; 14:nu14235163. [PMID: 36501192 PMCID: PMC9737639 DOI: 10.3390/nu14235163] [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: 11/08/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
The adoption of fiscal policies based on the specific taxation of sugar-sweetened beverages (SSBs) has been recommended by international health agencies, as they are measures that potentially reduce consumption. This study is an ex ante risk comparison that estimates the impact of three tax scenarios (20, 25, and 30%) with a 100% pass-on rate to SSBs on the prevalence of high weight and obesity in the Brazilian population. Data on the consumption habits, weight, and height of 46,164 adults aged 20 years or over from Brazilian recent national surveys were used. The shift in consumption after taxation was estimated based on the price elasticity of the demand. The percentage changes in overweight for 20, 25, and 30% taxation were 1.84% (95%CI: 1.82; 1.86), 1.89% (95%CI: 1.87; 1.90), and 2.25% (95%CI: 2.24; 2.27), respectively. The change in the prevalence of obesity was 1.93% (95%CI: 1.87; 2.00), 2.90% (95%CI: 2.80; 3.02), and 4.16% (95%CI: 4.01; 4.32), respectively. Taxes on SSBs may have a more favorable result among the heaviest consumers, who are young adults (20-29 years), especially men, thereby promoting a greater reduction in the prevalence of high weight and obesity.
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Smith NR, Grummon AH, Ng SW, Wright ST, Frerichs L. Simulation models of sugary drink policies: A scoping review. PLoS One 2022; 17:e0275270. [PMID: 36191026 PMCID: PMC9529101 DOI: 10.1371/journal.pone.0275270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Simulation modeling methods are an increasingly common tool for projecting the potential health effects of policies to decrease sugar-sweetened beverage (SSB) intake. However, it remains unknown which SSB policies are understudied and how simulation modeling methods could be improved. To inform next steps, we conducted a scoping review to characterize the (1) policies considered and (2) major characteristics of SSB simulation models. METHODS We systematically searched 7 electronic databases in 2020, updated in 2021. Two investigators independently screened articles to identify peer-reviewed research using simulation modeling to project the impact of SSB policies on health outcomes. One investigator extracted information about policies considered and key characteristics of models from the full text of included articles. Data were analyzed in 2021-22. RESULTS Sixty-one articles were included. Of these, 50 simulated at least one tax policy, most often an ad valorem tax (e.g., 20% tax, n = 25) or volumetric tax (e.g., 1 cent-per-fluid-ounce tax, n = 23). Non-tax policies examined included bans on SSB purchases (n = 5), mandatory reformulation (n = 3), warning labels (n = 2), and portion size policies (n = 2). Policies were typically modeled in populations accounting for age and gender or sex attributes. Most studies focused on weight-related outcomes (n = 54), used cohort, lifetable, or microsimulation modeling methods (n = 34), conducted sensitivity or uncertainty analyses (n = 56), and included supplementary materials (n = 54). Few studies included stakeholders at any point in their process (n = 9) or provided replication code/data (n = 8). DISCUSSION Most simulation modeling of SSB policies has focused on tax policies and has been limited in its exploration of heterogenous impacts across population groups. Future research would benefit from refined policy and implementation scenario specifications, thorough assessments of the equity impacts of policies using established methods, and standardized reporting to improve transparency and consistency.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah Towner Wright
- Health Sciences Library, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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Congdon P, Amugsi D. Editorial: The obesity epidemic: Causes, context, prevention. Front Public Health 2022; 10:1030180. [PMID: 36225791 PMCID: PMC9549261 DOI: 10.3389/fpubh.2022.1030180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/09/2022] [Indexed: 01/29/2023] Open
Affiliation(s)
- Peter Congdon
- School of Geography, Queen Mary University of London, London, United Kingdom,*Correspondence: Peter Congdon
| | - Dickson Amugsi
- African Population and Health Research Center, Nairobi, Kenya
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Revoredo-Giha C, McNamee P, Norwood P, Akaichi F, Dogbe W. Expenditure and Nutritional Impact of Banning the Promotion of Foods High in Fat, Sugar and Salt in Scotland. Front Nutr 2022; 9:874018. [PMID: 35845774 PMCID: PMC9277539 DOI: 10.3389/fnut.2022.874018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
The purpose of the paper is to provide an ex-ante evaluation of banning price promotions for discretionary foods (e. g., such as confectionary, crisps, biscuits, sweet and savory snacks, cakes) in Scotland. The methodology consisted of the estimation of demand systems by socioeconomic groups (i.e., lifestage and income groups) for 19 food groups using a highly product disaggregated dataset. These results were used to simulate scenarios consisting of eliminating price promotions on the discretionary food products for the entire sample and by group and analyzing nutritional results. The results indicated a net impact of reducing energy by 651 kcal per capita per week (C.I. −695, −608)1. Similar results were found for macro nutrients. There were some significant differences across different income and lifestage groups, with kcal energy reductions being significantly greater amongst household with lower income, and in households where respondents were aged 45 years or over. The analysis concluded that restrictions on the promotion of foods considered to be high in saturated fat, sugar, or salt (HFSS) are seen as one measure to improve the overall nutritional quality of foods consumed. Results indicate that restricting promotions has the potential to reduce the number of calories, sugar, saturated fats and sodium for most food groups.
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Affiliation(s)
- Cesar Revoredo-Giha
- Department of Rural Economy, Environment and Society, Scotland's Rural College, Edinburgh, United Kingdom
- *Correspondence: Cesar Revoredo-Giha
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Patricia Norwood
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Faical Akaichi
- Department of Rural Economy, Environment and Society, Scotland's Rural College, Edinburgh, United Kingdom
| | - Wisdom Dogbe
- Rowett Institute of Health and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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21
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Warren C, Hobin E, Manuel DG, Anderson LN, Hammond D, Jessri M, Arcand J, L'Abbé M, Li Y, Rosella LC, Manson H, Smith BT. Socioeconomic position and consumption of sugary drinks, sugar-sweetened beverages and 100% juice among Canadians: a cross-sectional analysis of the 2015 Canadian Community Health Survey–Nutrition. CANADIAN JOURNAL OF PUBLIC HEALTH 2022; 113:341-362. [PMID: 35138596 PMCID: PMC9043056 DOI: 10.17269/s41997-021-00602-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
Objective The aim of this study was to describe sugary drink (beverages with free sugars), sugar-sweetened beverage (beverages with added sugars, SSB) and 100% juice (beverages with natural sugars) consumption across socioeconomic position (SEP) among Canadians. Methods We conducted a cross-sectional analysis of 19,742 respondents of single-day 24-h dietary recalls in the nationally representative 2015 Canadian Community Health Survey–Nutrition. Poisson regressions were used to estimate the prevalence of consuming each beverage type on a given day. Among consumers on a given day, linear regressions were used to estimate mean energy intake. Models included household education, food security and income quintiles as separate unadjusted exposures. Sex-specific models were estimated separately for children/adolescents (2–18 years) and adults (19 +). Results Among female children/adolescents, the prevalence of consuming sugary drinks and, separately, SSB ranged from 11 to 21 and 8 to 27 percentage-points higher among lower education compared to ‘Bachelor degree or above’ households. In female adults, the prevalence of consuming sugary drinks and, separately, SSB was 10 (95% CI: 1, 19) and 14 (95% CI: 2, 27) percentage-points higher in food insecure compared to secure households. In males, the prevalence of consuming 100% juice was 9 (95% CI: − 18, 0) percentage-points lower among food insecure compared to secure households. Social inequities in energy intake were observed in female adult consumers, among whom mean energy from sugary drinks was 27 kcal (95% CI: 3, 51) higher among food insecure compared to secure and 35 kcal (95% CI: 2, 67) higher from 100% juice among ‘less than high school’ education compared to ‘Bachelor degree or above’ households. Conclusion Social inequities in sugary drink consumption exist in Canada. The associations differed by SEP indicator. Equitable interventions to reduce consumption are warranted.
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Affiliation(s)
- Christine Warren
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Erin Hobin
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Douglas G Manuel
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Institute for Clinical Evaluative Sciences - Central Site, Toronto, ON, Canada
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
- Department of Family Medicine, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Mahsa Jessri
- Food, Nutrition and Health Program, University of British Columbia, Vancouver, BC, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Mary L'Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Ye Li
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences - Central Site, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Vector Institute, Toronto, ON, Canada
- Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Heather Manson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brendan T Smith
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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22
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Vellakkal S, Khan Z, Alavani H, Fledderjohann J, Stuckler D. Effects of public policies in the prevention of cardiovascular diseases: a systematic review of global literature. Public Health 2022; 207:73-81. [PMID: 35567826 DOI: 10.1016/j.puhe.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public policies targeting unhealthy products could reduce cardiovascular diseases. STUDY DESIGN This study was a systematic review of the literature. METHODS We searched research studies published in 2000-2020 from major databases, including MEDLINE and Embase. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and narratively synthesized the studies based on vote counting and direction of the intervention effect. RESULTS Ninety-eight studies, mostly from high-income countries, met the inclusion criteria. Most studies were on public policies targeting sugar-sweetened beverages and tobacco, followed by alcohol, sugar, salt, and junk foods. Overall, many reported that several fiscal, regulatory, and educational policies generated beneficial effects of reducing the diseases. Those studies that reported no or limited effects highlighted several sociodemographic and health risk characteristics and design and implementation aspects of the policy interventions as factors limiting the policy effects; most of these are modifiable with appropriate policy interventions. For instance, low magnitude of tax, substitution with other unhealthy products, firms' competitive response strategies, pre-existence of smoking bans, incremental enactment of smoking regulations, degree of enforcement, and various sociocultural factors minimized the effects of the policies. CONCLUSION The literature supports a growing consensus on the beneficial effects of public policy for improving human health. The design and implementation of public policies must address various impeding factors and incorporate appropriate remedial measures. Further research is needed from low- and middle-income countries and on whether and how multiple policy instruments work in tandem.
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Affiliation(s)
- S Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kalyanpur, Uttar Pradesh, India.
| | - Z Khan
- IIPH Bhubaneshwar, Bhubaneshwar, Odisha, India
| | - H Alavani
- Department of Economics and Finance, BITS Pilani, KK Birla Goa Campus, Zuarinagar, Goa, India
| | - J Fledderjohann
- Department of Sociology, Lancaster University, Lancaster, UK
| | - D Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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23
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Vo V, Nguyen KH, Whitty JA, Comans TA. The Effect of Price Changes and Teaspoon Labelling on Intention to Purchase Sugar-Sweetened Beverages: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:199-212. [PMID: 34738192 DOI: 10.1007/s40258-021-00688-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Childhood obesity is a major public health concern and sugar-sweetened beverages (SSBs) are a known contributor. SSB taxation and food labelling have been proposed as policies to reduce consumption by changing purchasing behaviours. The study aimed to analyse caregivers' preferences on commonly purchased SSBs in Australia and to determine the effect of price increases and teaspoon labelling on their purchasing intentions. METHODS We used a discrete choice experiment (DCE) to obtain data about choices between SSB and non-SSB alternatives. 563 caregivers, who had young children aged 3-7 years, completed the experiment online. 286 were randomly allocated to receive choice sets with plain labelling while 277 were assigned to teaspoon labelling. Each participant completed nine choice scenarios where they chose between six SSB and non-SSB beverage options or a no-beverage option, with beverage prices varying between scenarios. While hypothetical, price and teaspoon labelling for sugar content for each beverage was obtained from an informal market survey. Responses from the DCE were modelled using random parameters logit within a random utility theory framework. Household income and children's consumption volumes of soft drink were used to explore preference heterogeneity. RESULTS Using mixed logit as the final model, we found that higher reduction in intended purchases was observed for soft drink and fruit drink in teaspoon labelling than it was in plain labelling. Participants exposed to teaspoon labelling intended to purchase less of flavoured milk and fruit juice compared to those exposed to plain labelling. Compared to baseline prices, a hypothetical 20% increase in SSB prices and the presentation of 'teaspoons of sugar' labelling were predicted to reduce intentional SSB purchases and increase intentional non-SSB purchases. Within each labelling group, there were no significant differences of intentional purchases between the highest and the lowest income quintile, high and low consumers of soft drinks. However, compared to plain labelling, teaspoon labelling was predicted to strongly influence intentional purchases of SSBs and non-SSBs. CONCLUSION This study suggests that a policy to increase SSB price and include teaspoon labelling would lead to a reduced consumption of SSBs and increased consumption of non-SSBs.
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Affiliation(s)
- Vinh Vo
- The Centre for Health Services Research, University of Queensland, St. Lucia, 288 Herston Road, Herston, QLD, 4006, Australia
- Centre for Health Economics, Monash University, Caufield East, Vic., Australia
| | - K-H Nguyen
- The Centre for Health Services Research, University of Queensland, St. Lucia, 288 Herston Road, Herston, QLD, 4006, Australia
| | - J A Whitty
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tracy A Comans
- The Centre for Health Services Research, University of Queensland, St. Lucia, 288 Herston Road, Herston, QLD, 4006, Australia.
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24
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Onwezen M. The application of systematic steps for interventions towards meat-reduced diets. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2021.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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25
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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.
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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
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Arrospide A, Ibarrondo O, Castilla I, Larrañaga I, Mar J. Development and Validation of a Discrete Event Simulation Model to Evaluate the Cardiovascular Impact of Population Policies for Obesity. Med Decis Making 2021; 42:241-254. [PMID: 34632840 PMCID: PMC8777309 DOI: 10.1177/0272989x211032964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Our aim was to describe the development and validation of an obesity model
representing the cardiovascular risks associated with different body mass
index (BMI) categories, through simulation, designed to evaluate the
epidemiological and economic impact of population policies for obesity. Methods A discrete event simulation model was built in R considering the risk of
cardiovascular events (heart failure, stroke, coronary heart disease, and
diabetes) associated with BMI categories in the Spanish population. The main
parameters included in the model were estimated from Spanish hospital
discharge records and the Spanish Health Survey and allowed both first-order
and second-order (probabilistic sensitivity analysis) uncertainty to be
programmed into the model. The simulation yielded the incidence and
prevalence of cardiovascular events as validation outputs. To illustrate the
capacity of the model, we estimated the reduction in cardiovascular events
and cost-utility (incremental cost/incremental quality-adjusted life-years
[QALYs]) of a hypothetical intervention that fully eliminated the
cardiovascular risks associated with obesity and overweight. Results The Validation Status of Health-Economic decision models (AdViSHE) tool was
applied. Internal validation plots showed adequate goodness of fit for the
Spanish population. External validation was achieved by comparing the
simulated and real incidence by age group for stroke, acute myocardial
infarction, and heart failure. The intervention reduced the population
hazard ratios of stroke, acute myocardial infarction, and heart failure to
0.81, 0.74, and 0.78, respectively, and added 0.74 QALYs to the whole
population. Conclusions This obesity simulation model evidenced good properties for estimating the
long-term epidemiological and economic impact of policies to tackle obesity
in Spain. The conceptual model could be implemented for other counties using
country-specific input data.
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Affiliation(s)
- Arantzazu Arrospide
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Arrasate-Mondragón, Pais Vasco, Spain.,Biodonostia Health Research Institute, Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Spain.,Kronikgune Institute for Health Services Research, Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Oliver Ibarrondo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Arrasate-Mondragón, Pais Vasco, Spain.,Biodonostia Health Research Institute, Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Spain
| | - Iván Castilla
- Kronikgune Institute for Health Services Research, Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.,Department of Informatics and Systems Engineering, University of La Laguna, La Laguna, Islas Canarias, Spain
| | - Igor Larrañaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Arrasate-Mondragón, Pais Vasco, Spain.,Biodonostia Health Research Institute, Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Spain.,Kronikgune Institute for Health Services Research, Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Javier Mar
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Arrasate-Mondragón, Pais Vasco, Spain.,Biodonostia Health Research Institute, Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Spain.,Kronikgune Institute for Health Services Research, Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
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Pan F, Owen N, Oddy WH. Sugar sweetened beverages and increasing prevalence of type 2 diabetes in the Indigenous community of Australia. Nutr Metab Cardiovasc Dis 2021; 31:2825-2830. [PMID: 34353701 DOI: 10.1016/j.numecd.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 11/20/2022]
Abstract
AIMS The aim of this viewpoint was to discuss a profound health gap in type 2 diabetes that exists between Indigenous and non-Indigenous Australians. DATA SYNTHESIS In Australia, type 2 diabetes is ranked as the fastest growing chronic condition, with the rates of type 2 diabetes higher among Indigenous than non-Indigenous Australians. Improvements to diet could aid in reducing overweight and obesity in the Indigenous community, with sugar sweetened beverages (SSBs) examples of discretionary foods that contain a high amount of sugar. The marked increase in type 2 diabetes, obesity and consumption of SSBs in the Indigenous community may suggest that type 2 diabetes may result from weight gain caused by SSB consumption. Recent evidence suggests that higher consumption of SSBs was associated with greater incidence of type 2 diabetes independent of adiposity. Some determinants influencing increased SSBs consumption in the Indigenous population include advertising, marketing, availability and affordability. CONCLUSIONS The prevalence rates of type 2 diabetes continue to be higher among Indigenous than non-Indigenous Australians and overall, a link between SSBs and risk of type 2 diabetes is reported. Three solutions to high SSBs consumption in Indigenous communities include increased availability, affordability, and accessibility of healthy food and drink, engagement of Indigenous people in offering solutions including discussion of a sugar tax on SSBs framed with Indigenous input, and the provision of clean community water supply and water bubblers.
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Affiliation(s)
- Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - Neville Owen
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia; Swinburne University of Technology, Hawthorn, 3122, Australia
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia.
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28
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Saha S, Nordström J, Scarborough P, Thunström L, Gerdtham UG. In search of an appropriate mix of taxes and subsidies on nutrients and food: A modelling study of the effectiveness on health-related consumption and mortality. Soc Sci Med 2021; 287:114388. [PMID: 34520938 DOI: 10.1016/j.socscimed.2021.114388] [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: 12/10/2020] [Revised: 07/21/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Taxes and subsidies on foods and nutrients have the potential to promote healthier diets and thereby reduce mortality. In this study, we examine the effects of such policy instruments on Swedish public health. Specifically, we estimate the effects of food and nutrient taxes and subsidies on mortality averted and postponed in Sweden, using both demand system estimations and simulation models. We evaluate different Value Added Tax (VAT) reforms. The VAT is raised on food products that are particularly rich in saturated fat or salt and lowered on fruit and vegetables. Our models predict that an increase in the current VAT of 12% on food, to 25% VAT on products rich in saturated fat plus a 0% VAT on fruits and vegetables would result in almost 1100 deaths (95% CI: -832; -1363) averted or postponed in a year in Sweden, while the combination of a 34.4% VAT on products rich in saturated fat and a -10.4% VAT (i.e. a subsidy) on fruits and vegetables would result in almost 2100 (95% CI: -1572; -2311) deaths averted or postponed corresponding to a 4.8% reduction in diet-related annual death. Most of the deaths averted or delayed from this reform would be deaths from coronary heart disease (-1,148, 95% CI: -728; -1586), followed by stroke -641 (95% CI: -408; -887) and diet-related cancer deaths (-288, 95% CI: -11; -435). We find that health-related food taxes and subsidies improve dietary habits as well as reduce the mortality of the Swedish population. However, the effect of these reforms on different socioeconomic classes and which reforms provide the best value for money, i.e., cost-effectiveness of these reforms needs to be established first before implementation.
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Affiliation(s)
- Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden.
| | - Jonas Nordström
- Lund University School of Economics and Management, Agrifood Economics Centre, Lund, Sweden; Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark; School of Technology and Business Studies, Dalarna University, Sweden.
| | - Peter Scarborough
- Nuffield Department of Population Health & NIHR Biomedical Research Centre at Oxford, University of Oxford, Oxford, United Kingdom.
| | - Linda Thunström
- Department of Economics, University of Wyoming, Laramie, WY, United States.
| | - Ulf-G Gerdtham
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden; Department of Economics, Lund University, Lund, Sweden.
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29
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Hoenink JC, Waterlander WE, Mackenbach JD, Mhurchu CN, Wilson N, Beulens JWJ, Nghiem N. Impact of taxes on purchases of close substitute foods: analysis of cross-price elasticities using data from a randomized experiment. Nutr J 2021; 20:75. [PMID: 34493309 PMCID: PMC8424883 DOI: 10.1186/s12937-021-00736-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To examine the effects of health-related food taxes on substitution and complementary purchases within food groups, including from unhealthier to healthier alternatives and between brands. METHODS We used data from a virtual supermarket experiment with data from 4,259 shopping events linked to varying price sets. Substitution or complementary effects within six frequently purchased food categories were analyzed. Products' own- and cross-price elasticities were analyzed using Almost Ideal Demand System models. RESULTS Overall, 37.5% of cross-price elasticities were significant (p < 0.05) and included values greater than 0.10. Supplementary and complementary effects were particularly found in the dairy, meats and snacks categories. For example, a 1% increase in the price of high saturated fat dairy was associated with a 0.18% (SE 0.06%) increase in purchases of low saturated fat dairy. For name- and home-brand products, significant substitution effects were found in 50% (n = 3) of cases, but only in one case this was above the 0.10 threshold. CONCLUSIONS/POLICY IMPLICATIONS Given the relatively low own-price elasticities and the limited substitution and complementary effects, relatively high taxes are needed to substantively increase healthy food purchases at the population level. TRIAL REGISTRATION This study included secondary analyses; the original trial was registered in the Australian New Zealand Clinical Trials Registry ACTRN12616000122459 .
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Affiliation(s)
- Jody C Hoenink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, De Boelelaan 1089a, 1081 HV, Amsterdam, the Netherlands. .,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Wilma E Waterlander
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Joreintje D Mackenbach
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, De Boelelaan 1089a, 1081 HV, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Joline W J Beulens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, De Boelelaan 1089a, 1081 HV, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nhung Nghiem
- Department of Public Health, University of Otago, Wellington, New Zealand
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30
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Alcaraz A, Pichon-Riviere A, Palacios A, Bardach A, Balan DJ, Perelli L, Augustovski F, Ciapponi A. Sugar sweetened beverages attributable disease burden and the potential impact of policy interventions: a systematic review of epidemiological and decision models. BMC Public Health 2021; 21:1460. [PMID: 34315428 PMCID: PMC8317409 DOI: 10.1186/s12889-021-11046-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Around 184,000 deaths per year could be attributable to sugar-sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions. METHODS We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model's features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. Studies published before 2003, cost of illness studies and economic evaluations based on individual patient data were excluded. RESULTS We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high-income countries and 57.5% considered a health system perspective. The most common model's outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either entirely through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -such us obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% by selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), taxes being the most frequent strategy (75%). CONCLUSIONS There is a wide range of modelling approaches of different complexity and information requirements to evaluate the burden of disease attributable to SSBs. Most of them take into account the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could result in useful information for decision makers and the general population to promote a deeper implementation of policies to reduce SSBs consumption. PROSPERO PROTOCOL NUMBER CRD42020121025 .
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Affiliation(s)
- Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Dario Javier Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Taxing sugar-sweetened beverages as a policy to reduce overweight and obesity in countries of different income classifications: a systematic review. Public Health Nutr 2021; 24:5550-5560. [PMID: 34218837 DOI: 10.1017/s1368980021002901] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the potential impact of sugar-sweetened beverage (SSB) taxes on overweight and obesity prevalence in countries of different income classifications. DESIGN Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020161612). Five databases (Cochrane Library, Embase, LILACS (via Virtual Health Library) and MEDLINE (via PubMed), and Web of Science were searched, from January 2009 to December 2019. Articles that reported changes in purchases, sales, intake, body weight, BMI, overweight and/or obesity prevalence due to a tax on or price change in SSB were included. SETTING Studies conducted in countries of different income classifications. PARTICIPANTS The search yielded 8349 articles of which 21 met inclusion criteria. RESULTS Among the sixteen studies selected, only two did not show that consumption, sales and purchase decreased as the price of SSB increased. In eight of the thirteen studies selected, a positive effect of an SSB tax on decreasing overweight and obesity prevalence was expected. It is estimated that a 20 % taxation on SSB would result in a greater decrease in the prevalence of overweight and obesity compared to a 10 % rate. Studies with no significant effect of taxing on sales, purchases, consumption and prevalence of obesity were from high-income countries, while significant effects of taxing on reducing purchase, consumption and/or obesity prevalence were found in studies from upper-middle- and middle-income countries. CONCLUSION A high SSB tax might be an effective fiscal policy to decrease purchase and consumption of SSB and reduce overweight/obesity prevalence, especially if the tax were specific for beverage volume.
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Wang Y, Zhao L, Gao L, Pan A, Xue H. Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol 2021; 9:446-461. [PMID: 34097869 DOI: 10.1016/s2213-8587(21)00118-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022]
Abstract
China has experienced many drastic social and economic changes and shifts in people's lifestyles since the 1990s, in parallel with the fast rising prevalence of obesity. About half of adults and a fifth of children have overweight or obesity according to the Chinese criteria, making China the country with the highest number of people with overweight or obesity in the world. Assuming that observed time trends would continue in the future, we projected the prevalence of and the number of people affected by overweight and obesity by 2030, and the associated medical costs. The rising incidence of obesity and number of people affected, as well as the related health and economic consequences, place a huge burden on China's health-care system. China has made many efforts to tackle obesity, including the implementation of relevant national policies and programmes. However, these measures are inadequate for controlling the obesity epidemic. In the past decade, China has attached great importance to public health, and the Healthy China 2030 national strategy initiated in 2016 provides a historical opportunity to establish comprehensive national strategies for tackling obesity. China is well positioned to explore an effective model to overcome the obesity epidemic; however, strong commitment and leadership from central and local governments are needed, as well as active participation of all related society sectors and individual citizens. TRANSLATION: For the Chinese translation of the paper see Supplementary Materials section.
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Affiliation(s)
- Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China.
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Liwang Gao
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA
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Phonsuk P, Vongmongkol V, Ponguttha S, Suphanchaimat R, Rojroongwasinkul N, Swinburn BA. Impacts of a sugar sweetened beverage tax on body mass index and obesity in Thailand: A modelling study. PLoS One 2021; 16:e0250841. [PMID: 33914822 PMCID: PMC8084227 DOI: 10.1371/journal.pone.0250841] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/15/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends sugar-sweetened beverage (SSB) taxes to address obesity. Thailand has just launched the new tax rates for SSB in 2017; however, the existing tax rate is not as high as the 20% recommended by the WHO. The objective for this study was to estimate the impacts of an SSB tax on body mass index (BMI) and obesity prevalence in Thailand under three different scenarios based on existing SSB and recommended tax rates. METHODS A base model was built to estimate the impacts of an SSB tax on SSB consumption, energy intake, BMI, and obesity prevalence. Literature review was conducted to estimate pass on rate, price elasticity, energy compensation, and energy balance to weight change. Different tax rates (11%, 20% and 25%) were used in the model. The model assumed no substitution effects, model values were based on international data since there was no empirical Thai data available. Differential effects by income groups were not estimated. FINDINGS When applying 11%, 20%, and 25% tax rates together with 100% pass on rate and an -1.30 own-price elasticity, the SSB consumption decreased by 14%, 26%, and 32%, respectively. The 20% and 25% price increase in SSB price tended to reduce higher energy intake, weight status and BMI, when compared with an 11% increase in existing price increase of SSB. The percentage changes of obesity prevalence of 11%, 20% and 25% SSB tax rates were estimated to be 1.73%, 3.83%, and 4.91%, respectively. CONCLUSIONS A higher SSB tax (20% and 25%) was estimated to reduce consumption and consequently decrease obesity prevalence. Since Thailand has already endorsed the excise tax structure, the new excise tax structure for SSB should be scaled up to a 20% or 25% tax rate if the SSB consumption change does not meet a favourable goal.
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Affiliation(s)
- Payao Phonsuk
- International Health Policy Program, Nonthaburi, Thailand
| | | | | | - Rapeepong Suphanchaimat
- International Health Policy Program, Nonthaburi, Thailand
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
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Morgan K, Lowthian E, Hawkins J, Hallingberg B, Alhumud M, Roberts C, Murphy S, Moore G. Sugar-sweetened beverage consumption from 1998-2017: Findings from the health behaviour in school-aged children/school health research network in Wales. PLoS One 2021; 16:e0248847. [PMID: 33852585 PMCID: PMC8046241 DOI: 10.1371/journal.pone.0248847] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/06/2021] [Indexed: 11/18/2022] Open
Abstract
To date no study has examined time trends in adolescent consumption of sugar-sweetened beverages and energy drinks, or modelled change in inequalities over time. The present study aimed to fill this gap by identifying historical trends among secondary school students in Wales, United Kingdom. The present study includes 11–16 year olds who completed the Health Behaviour in School-aged Children (HBSC) survey and the Welsh School Health Research Network (SHRN) survey between 1998 to 2017. Multinomial regression models were employed alongside tests for interaction effects. A total of 176,094 student responses were assessed. From 1998 to 2017, the prevalence of daily sugar-sweetened beverage consumption decreased (57% to 18%) while weekly consumption has remained constant since 2006 (49% to 52%). From 2013 to 2017, daily consumption of energy drinks remained stable (6%) while weekly consumption reports steadily decreased (23% to 15%). Boys, older children and those from a low socioeconomic group reported higher consumption rates of sugar-sweetened beverages and energy drinks. Consumption according to socioeconomic group was the only characteristic to show a statistically significant change over time, revealing a widening disparity between sugar-sweetened beverage consumption rates of those from low and high socioeconomic groups. Findings indicate a positive shift in overall consumption rates of both sugar-sweetened beverages and energy drinks. Adolescents from a low socioeconomic group however were consistently shown to report unfavourable sugar-sweetened beverages consumption when compared to peers from high socioeconomic group. Given the established longer term impacts of sugar-sweetened beverage and energy drink consumption on adolescent health outcomes, urgent policy action is required to reduce overall consumption rates, with close attention to equity of impact throughout policy design and evaluation plans.
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Affiliation(s)
- Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Emily Lowthian
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jemma Hawkins
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Britt Hallingberg
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Manal Alhumud
- Applied Medical Sciences, Community Health Sciences, King Saudi University, Riyadh, Saudi Arabia
| | - Chris Roberts
- Knowledge and Analytical Services, Welsh Government, Cardiff, United Kingdom
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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Modelling the size, cost and health impacts of universal basic income: What can be done in advance of a trial? HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021; 21:459-476. [PMID: 33867814 PMCID: PMC8036241 DOI: 10.1007/s10742-021-00246-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/26/2021] [Accepted: 03/21/2021] [Indexed: 11/14/2022]
Abstract
Opposition to Universal Basic Income (UBI) is encapsulated by Martinelli’s claim that ‘an affordable basic income would be inadequate, and an adequate basic income would be unaffordable’. In this article, we present a model of health impact that transforms that assumption. We argue that UBI can affect higher level social determinants of health down to individual determinants of health and on to improvements in public health that lead to a number of economic returns on investment. Given that no trial has been designed and deployed with that impact in mind, we present a methodological framework for assessing prospective costs and returns on investment through modelling to make the case for that trial. We begin by outlining the pathways to health in our model of change in order to present criteria for establishing the size of transfer capable of promoting health. We then consider approaches to calculating cost in a UK context to estimate budgetary burdens that need to be met by the state. Next, we suggest means of modelling the prospective impact of UBI on health before asserting means of costing that impact, using a microsimulation approach. We then outline a set of fiscal options for funding any shortfall in returns. Finally, we suggest that fiscal strategy can be designed specifically with health impact in mind by modelling the impact of reform on health and feeding that data cyclically back into tax transfer module of the microsimulation.
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Shahid A, Nguyen TAN, Kechadi MT. Big Data Warehouse for Healthcare-Sensitive Data Applications. SENSORS 2021; 21:s21072353. [PMID: 33800574 PMCID: PMC8037603 DOI: 10.3390/s21072353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/22/2023]
Abstract
Obesity is a major public health problem worldwide, and the prevalence of childhood obesity is of particular concern. Effective interventions for preventing and treating childhood obesity aim to change behaviour and exposure at the individual, community, and societal levels. However, monitoring and evaluating such changes is very challenging. The EU Horizon 2020 project "Big Data against Childhood Obesity (BigO)" aims at gathering large-scale data from a large number of children using different sensor technologies to create comprehensive obesity prevalence models for data-driven predictions about specific policies on a community. It further provides real-time monitoring of the population responses, supported by meaningful real-time data analysis and visualisations. Since BigO involves monitoring and storing of personal data related to the behaviours of a potentially vulnerable population, the data representation, security, and access control are crucial. In this paper, we briefly present the BigO system architecture and focus on the necessary components of the system that deals with data access control, storage, anonymisation, and the corresponding interfaces with the rest of the system. We propose a three-layered data warehouse architecture: The back-end layer consists of a database management system for data collection, de-identification, and anonymisation of the original datasets. The role-based permissions and secured views are implemented in the access control layer. Lastly, the controller layer regulates the data access protocols for any data access and data analysis. We further present the data representation methods and the storage models considering the privacy and security mechanisms. The data privacy and security plans are devised based on the types of collected personal, the types of users, data storage, data transmission, and data analysis. We discuss in detail the challenges of privacy protection in this large distributed data-driven application and implement novel privacy-aware data analysis protocols to ensure that the proposed models guarantee the privacy and security of datasets. Finally, we present the BigO system architecture and its implementation that integrates privacy-aware protocols.
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Breda J, Allen LN, Tibet B, Erguder T, Karabulut E, Yildirim HH, Mok A, Wickramasinghe K. Estimating the impact of achieving Turkey's non-communicable disease policy targets: A macro-simulation modelling study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 1:100018. [PMID: 33928267 PMCID: PMC8063152 DOI: 10.1016/j.lanepe.2020.100018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Burden of non-communicable disease (NCDs) has continued to rise globally, particularly in low- and middle-income countries. In Turkey, NCDs account for 89% of all deaths, with nearly one in five deaths occurring before age 70. This study investigates the number of NCD deaths that could be prevented if Turkey met national and international targets for major modifiable NCD risk factors. METHODS Preventable deaths were estimated using the World Health Organization (WHO) 'Preventable Risk Integrated ModEl' (PRIME), by combining: 1) Baseline exposure data for risk factors, referenced from national surveillance and cohort studies; 2) Aetiological associations from published meta-analyses; and 3) Demographic and mortality statistics obtained from the Turkish Statistical Institute (TurkStat). Confidence intervals were estimated using Monte Carlo simulations. FINDINGS If Turkey met its NCD risk factor targets for reducing tobacco and salt consumption by 30%, and physical inactivity by 10% in 2017, an estimated 19,859 deaths (95%CI: 12,802 to 26,609) could have been prevented. Approximately two thirds of these preventable deaths were in men, and one in three were in adults below 75 years. A 30% relative reduction in the consumption of alcohol, tobacco, and salt, as well as physical inactivity, would prevent 180 (107 to 259); 4,786 (3,679 to 5,836); 13,112 (5,819 to 19,952); and 7,124 (5,053 to 9,212) deaths, respectively. INTERPRETATION Among major modifiable NCD risk factors, population-level reductions in salt intake and physical inactivity present the greatest opportunity for reducing NCD mortality in Turkey. These findings can help Turkey prioritise interventions to meet the Sustainable Development Goal target of reducing NCD mortality by one third, by 2030.
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Affiliation(s)
- João Breda
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Luke N Allen
- GP Academic Clinical Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG UK
| | - Birol Tibet
- Izmir Biomedicine and Genome Center, Izmir, Turkey
- PhD Candidate, Istanbul University Istanbul Faculty of Medicine Department of Public Health, Istanbul, Turkey
| | - Toker Erguder
- National Professional Officer, World Health Organization Noncommunicable Diseases and Promoting Health through the Life-Course
| | - Erdem Karabulut
- Hacettepe University Faculty of Medicine Department of Biostatistics, Ankara, Turkey
| | - Hasan H Yildirim
- Health Institutes of Turkey Turkish Institute for Health Policies, Ministry of Health, Ankara, Turkey
| | - Alexander Mok
- WHO European Office for the Prevention and Control of Noncommunicable Diseases Russian Federation
| | - Kremlin Wickramasinghe
- World Health Organization Regional Office for Europe Russian Federation
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok 125009 Moscow, Russian Federation
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Chung LMY, Fong SSM, Law QPS. Younger Adults Are More Likely to Increase Fruit and Vegetable Consumption and Decrease Sugar Intake with the Application of Dietary Monitoring. Nutrients 2021; 13:nu13020333. [PMID: 33498678 PMCID: PMC7911637 DOI: 10.3390/nu13020333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/14/2022] Open
Abstract
Establishing healthy eating habits is considered to be a sustainable strategy for health maintenance, and mobile applications (apps) are expected to be highly effective among the young-aged population for healthy eating promotion. The purpose of this study was to investigate the effectiveness of a dietary monitoring app on younger adults’ nutrition knowledge and their dietary habits. A controlled-experimental study was performed with one experimental group having a three-hour nutrition seminar and 12 weeks of dietary monitoring with the app, and one control group receiving a three-hour nutrition seminar. Behavioral feedback delivered by the app was evaluated in facilitating the transfer of nutritional knowledge to nutrition behavior. A total of 305 younger adults aged from 19 to 31 were recruited. Baseline and post-intervention nutrition knowledge and dietary behavior were collected. All mean scores of post-GNKQ-R increased from baseline for both the control and the experimental groups. The mean differences of sugar intake, dietary fiber intake, and vitamin C intake for the experimental group were significantly more than those for the control group (all p < 0.001). In addition, the experimental group increased fruit and vegetable consumption significantly more than the control group (all p < 0.001). For those younger adults with a relatively large body size, they were more likely to increase fruit consumption with the application of dietary monitoring.
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Affiliation(s)
- Louisa Ming Yan Chung
- Department of Health and Physical Education, The Education Unversity of Hong Kong, Tai Po, New Territories, Hong Kong, China;
- Correspondence:
| | - Shirley Siu Ming Fong
- Department of Health and Physical Education, The Education Unversity of Hong Kong, Tai Po, New Territories, Hong Kong, China;
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Kruger P, Abdool Karim S, Tugendhaft A, Goldstein S. An Analysis of the Adoption and Implementation of A Sugar-Sweetened Beverage Tax in South Africa: A Multiple Streams Approach. Health Syst Reform 2021; 7:e1969721. [PMID: 34606415 DOI: 10.1080/23288604.2021.1969721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This paper describes a case study of the adoption and implementation of the sugar-sweetened beverage tax in South Africa, termed the Health Promotion Levy. Qualitative data extraction and analysis of institutional documents, such as policy proposals and parliamentary debate records, stakeholder submissions to Parliament and media reports, were guided by the Kingdon Multiple Streams Theory as adapted to study agenda setting, policy adoption, and implementation. We present the following key findings: First, consistent messaging from policy entrepreneurs, consisting of advocacy groups, health organizations, and research entities, was key to ensuring that a tax policy solution was proposed and passed. Second, the continuity of certain key policymakers contributed to the relatively expedient passage of the tax policy. Third, the use of an excise tax was, amongst others, an appealing policy solution because of its revenue-raising potential; however, uncertainty regarding the purpose of the tax negatively impacted public attitudes toward it. Fourth, industry arguments, relating to unemployment, were effective in restructuring the tax in favor of industry actors. Finally, regulatory action by sectors outside of finance and health impacted stakeholder perceptions of the tax and possibly obstructed regular annual adjustments for inflation.
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Affiliation(s)
- 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
| | - Safura Abdool Karim
- 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
| | - Aviva Tugendhaft
- 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
| | - 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
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Segovia J, Orellana M, Sarmiento JP, Carchi D. The effects of taxing sugar-sweetened beverages in Ecuador: An analysis across different income and consumption groups. PLoS One 2020; 15:e0240546. [PMID: 33048990 PMCID: PMC7553359 DOI: 10.1371/journal.pone.0240546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
To analyze the effects of taxing sugar-sweetened beverages (SSBs) in Ecuador, this study estimates a Quadratic Almost Ideal Demand System model using data from the 2011–2012 National Survey of Income and Expenditure for Urban and Rural Households. We derive own- and cross-price elasticities by income quintiles and consumption deciles for five beverages, including two types of sugary drink: (i) milk, (ii) soft drinks, (iii) water, (iv) other sugary drinks, and (v) coffee and tea. Overall, results show that a 20% increase in the price of SSBs will decrease the consumption of soft drinks and other sugary drinks by 27% and 22%, respectively. Heterogeneous consumer behavior is revealed across income and consumption groups, as well as policy-relevant complementarity and substitution patterns. Policy impacts are simulated by considering an 18 cents per liter tax, implemented in Ecuador, and an ad-valorem 20% tax on the price. Estimated tax revenues and weight loss are larger for the latter. From a health perspective, high-income and heavy consumer households would benefit the most from this policy. Our study supports an evidence-based debate on how to correctly design and monitor food policy.
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Affiliation(s)
- Joselin Segovia
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca, Azuay, Ecuador
- * E-mail:
| | - Mercy Orellana
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca, Azuay, Ecuador
| | - Juan Pablo Sarmiento
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca, Azuay, Ecuador
| | - Darwin Carchi
- Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca, Azuay, Ecuador
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Green A, Nemecek T, Chaudhary A, Mathys A. Assessing nutritional, health, and environmental sustainability dimensions of agri-food production. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2020. [DOI: 10.1016/j.gfs.2020.100406] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Berger N, Cummins S, Allen A, Smith RD, Cornelsen L. Patterns of beverage purchases amongst British households: A latent class analysis. PLoS Med 2020; 17:e1003245. [PMID: 32898152 PMCID: PMC7478648 DOI: 10.1371/journal.pmed.1003245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/03/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Beverages, especially sugar-sweetened beverages (SSBs), have been increasingly subject to policies aimed at reducing their consumption as part of measures to tackle obesity. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. We fill this gap by creating a typology of beverage consumers in Great Britain (GB) based on observed beverage purchasing behaviour to determine what distinct types of beverage consumers exist, and what their socio-demographic (household) characteristics, dietary behaviours, and weight status are. METHODS AND FINDINGS We used cross-sectional latent class analysis to characterise patterns of beverage purchases. We used data from the 2016 GB Kantar Fast-Moving Consumer Goods (FMCG) panel, a large representative household purchase panel of food and beverages brought home, and restricted our analyses to consumers who purchase beverages regularly (i.e., >52 l per household member annually) (n = 8,675). Six categories of beverages were used to classify households into latent classes: SSBs; diet beverages; fruit juices and milk-based beverages; beer and cider; wine; and bottled water. Multinomial logistic regression and linear regression were used to relate class membership to household characteristics, self-reported weight status, and other dietary behaviours, derived from GB Kantar FMCG. Seven latent classes were identified, characterised primarily by higher purchases of 1 or 2 categories of beverages: 'SSB' (18% of the sample; median SSB volume = 49.4 l/household member/year; median diet beverage volume = 38.0 l), 'Diet' (16%; median diet beverage volume = 94.4 l), 'Fruit & Milk' (6%; median fruit juice/milk-based beverage volume = 30.0 l), 'Beer & Cider' (7%; median beer and cider volume = 36.3 l; median diet beverage volume = 55.6 l), 'Wine' (18%; median wine volume = 25.5 l; median diet beverage volume = 34.3 l), 'Water' (4%; median water volume = 46.9 l), and 'Diverse' (30%; diversity of purchases, including median SSB volume = 22.4 l). Income was positively associated with being classified in the Diverse class, whereas low social grade was more likely for households in the classes SSB, Diet, and Beer & Cider. Obesity (BMI > 30 kg/m2) was more prevalent in the class Diet (41.2%, 95% CI 37.7%-44.7%) despite households obtaining little energy from beverages in that class (17.9 kcal/household member/day, 95% CI 16.2-19.7). Overweight/obesity (BMI > 25 kg/m2) was above average in the class SSB (66.8%, 95% CI 63.7%-69.9%). When looking at all groceries, households from the class SSB had higher total energy purchases (1,943.6 kcal/household member/day, 95% CI 1,901.7-1,985.6), a smaller proportion of energy from fruits and vegetables (6.0%, 95% CI 5.8%-6.3%), and a greater proportion of energy from less healthy food and beverages (54.6%, 95% CI 54.0%-55.1%) than other classes. A greater proportion of energy from sweet snacks was observed for households in the classes SSB (18.5%, 95% CI 18.1%-19.0%) and Diet (18.8%, 95% CI 18.3%-19.3%). The main limitation of our analyses, in common with other studies, is that our data do not include information on food and beverage purchases that are consumed outside the home. CONCLUSIONS Amongst households that regularly purchase beverages, those that mainly purchased high volumes of SSBs or diet beverages were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.
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Affiliation(s)
- Nicolas Berger
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sciensano, Brussels, Belgium
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexander Allen
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard D. Smith
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Kao KE, Jones AC, Ohinmaa A, Paulden M. The health and financial impacts of a sugary drink tax across different income groups in Canada. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100869. [PMID: 32442926 DOI: 10.1016/j.ehb.2020.100869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Overconsumption of sugar-sweetened beverages (SSBs) contributes to childhood and adult obesity and numerous related diseases, including heart disease, strokes, cancers, and type 2 diabetes. It also increases healthcare costs. Sugary drink taxes have been implemented in several countries to curb sugar intake. However, there is a concern that sugary drink taxes are regressive. This study assessed the health and financial impacts of a simulated sugary drink tax across different income groups in Canada. METHODS A proportional multi-state life table-based Markov model simulated the 2016 Canadian population by income quintile. The model applied a 20 % tax on sugary drinks and determined the effects on type 2 diabetes and BMI-related diseases compared to no intervention. The income-specific parameters modelled included: population demographics; cross- and own-price elasticities; mean BMI; sugary drink consumption; mortality; and disease epidemiology. RESULTS A 20 % sugary drink tax was estimated to reduce the consumption of sugary drinks by an average of around 15 %, with a greater reduction in the lowest income quintile. The estimated mean reduction in BMI ranged from 0.21 to 0.33, dependent upon sex and income quintile; these reductions were greater among the lower income quintiles for both females and males. The 20 % sugary drink tax was estimated to avert approximately 690,000 DALYs over a lifetime among the 2016 Canadian adult population; estimated DALYs averted were approximately 156,000, 140,000, 137,000, 134,000, and 125,000 for the lowest through to the highest income quintile, respectively. Lifetime health care savings were estimated to be $2.27bn, $2.16bn, $2.17bn, $2.12bn, and $1.98bn for the lowest through to the highest income quintile, respectively. The estimated annual tax burden for the 2016 Canadian population was $1.4bn. The average absolute tax burden was estimated to be $39.00 to $44.30 per person, with the middle-income quintile bearing the heaviest absolute tax burden. The lowest income quintile would pay the highest proportion of income in tax, implying that the tax is regressive. CONCLUSIONS Low-income Canadians would gain the most health benefit from a sugary drinks tax. However, the lowest income quintile would also pay the largest proportion of income in tax. A tax on sugary drinks is therefore financially regressive but forecast to reduce health disparities across Canada.
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Affiliation(s)
- Kai-Erh Kao
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Amanda C Jones
- Department of Public Health, University of Otago, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Mike Paulden
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
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The effect of food taxes and subsidies on population health and health costs: a modelling study. LANCET PUBLIC HEALTH 2020; 5:e404-e413. [DOI: 10.1016/s2468-2667(20)30116-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022]
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Jain V, Crosby L, Baker P, Chalkidou K. Distributional equity as a consideration in economic and modelling evaluations of health taxes: A systematic review. Health Policy 2020; 124:919-931. [PMID: 32718790 DOI: 10.1016/j.healthpol.2020.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE/SETTING The extent to which distributional equity is incorporated into evaluations of the (potential or observed) impact of health taxes is unclear. This systematic review of economic and modelling evaluations investigating taxation on tobacco, sugar-sweetened-beverages (SSBs), or alcohol aims to assess the proportion that have considered distributional impact by income or socioeconomic group. Secondary aims included summarising the reported distributional impacts, for both costs and health benefits. FINDINGS Of 4656 search results, 69 studies were included. The majority were economic analyses with epidemiological modelling, with studies on SSB taxes being of the highest quality. Tobacco was most commonly investigated tax, with 37 evaluations. Of these, 12 (32 %) considered distributional equity, with six (27 %) of 22 included SSB evaluations doing the same, and none for alcohol. A tobacco tax favoured lowerincome groups in the distribution of costs in all identified evaluations and for health benefits in nine out of 12 evaluations (75 %). For SSBs, four evaluations (67 %) found costs to favour low-income groups, with three (50 %) for health benefits. CONCLUSIONS Despite recommendations, evaluations of health taxes do not routinely consider the distributional impact of both costs and health benefits. Evaluations for alcohol taxation are particularly weak in this regard. Where investigated, the majority of evidence found tobacco taxation to favour low-income groups, whereas the limited evidence for SSBs is mixed.
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Affiliation(s)
- Vageesh Jain
- Institute for Global Health (IGH), University College London, UK; Public Health England, London, UK.
| | - Liam Crosby
- Institute for Epidemiology and Healthcare, University College London, London, UK; Tower Hamlets Council, London, UK
| | - Peter Baker
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
| | - Kalipso Chalkidou
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
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Public acceptability of a sugar-sweetened beverage tax and its associated factors in the Netherlands. Public Health Nutr 2020; 24:2354-2364. [PMID: 32495730 PMCID: PMC8145443 DOI: 10.1017/s1368980020001500] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: To investigate the level of public acceptability of a sugar-sweetened beverage (SSB) tax and its associated factors. Design: Participants completed an online self-administered questionnaire. Acceptability of an SSB tax was measured on a seven-point Likert scale (strongly disagree to strongly agree). Associations between acceptability and sociodemographic factors, weight status, SSB consumption and beliefs about effectiveness (e.g., ‘An SSB tax would reduce people’s SSB consumption’), appropriateness, socioeconomic and economic benefit, implementation and trust were assessed using multivariable linear regression analyses. Setting: The Netherlands. Participants: Dutch adults aged ≥18 years representative of the Dutch population for age, sex, education level and location (n 500). Results: Of the participants, 40 % supported and 43 % opposed an SSB tax in general. Moreover, 42 % supported (43 % opposed) an SSB tax as a strategy to reduce overweight, and 55 % supported (32 % opposed) an SSB tax if revenue is used for health initiatives. Participants with a low education level (B = –0·82, 95 % CI –1·31, –0·32), overweight (B = –0·49, 95 % CI –0·89, –0·09), moderate or high SSB consumption (B = –0·86, 95 % CI –1·30, –0·43 and B = –1·01, 95 % CI –1·47, –0·56, respectively) and households with adolescents (B = –0·57, 95 % CI –1·09, –0·05) reported a lower acceptability of an SSB tax than their counterparts. Beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust were associated with acceptability (P < 0·001). Conclusions: Public acceptability of an SSB tax tends to be higher if revenue is used for health initiatives. The factors associated with acceptability should be taken into consideration.
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Sugar-sweetened beverage consumption and association with weight status in Irish children: a cross-sectional study prior to the introduction of a government tax on sugar-sweetened beverages. Public Health Nutr 2020; 23:2234-2244. [PMID: 32460948 DOI: 10.1017/s1368980020000014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To provide baseline evidence of sugar-sweetened beverage (SSB) consumption in a sample of Irish children prior to the introduction of the SSB tax; to identify the energy contribution of SSB to daily energy intake; and to explore the association between SSB consumption and overweight/obesity. DESIGN Cross-sectional study. SETTING Primary schools in Cork, Ireland in 2012. PARTICIPANTS 1075 boys and girls aged 8-11 years. SSB consumption was assessed from 3-d food diaries. BMI was used to define obesity (International Obesity Taskforce definitions). Plausible energy reporters (n 724, 68 % of total sample) were classified using Schofield equation. RESULTS Eighty-two per cent of children with plausible energy intake consumed SSB. Mean energy intake from SSB was 485 kJ (6 % of total kJ). Mean kilojoules from SSB increased with weight status from 443 kJ for normal-weight children to 648 kJ for children with overweight/obesity (5·8 and 7·6 % of total kJ, respectively). Mean SSB intake was significantly higher in children with overweight/obesity than normal-weight children (383 and 315 ml/d). In adjusted analyses, children consuming >200 ml/d had an 80 % increased odds of overweight/obesity compared to those consuming <200 ml/d (OR 1·8, 95 % CI 1·0, 3·5). Family socioeconomic status and lifestyle determinants, including frequency of takeaway consumption and TV viewing, were also significantly associated with SSB consumption. CONCLUSIONS SSB account for a substantial proportion of daily energy intake and are significantly associated with child overweight/obesity. This study provides baseline data from a sample of children from which the impact of the SSB tax can be benchmarked.
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Blakely T, Nghiem N, Genc M, Mizdrak A, Cobiac L, Mhurchu CN, Swinburn B, Scarborough P, Cleghorn C. Modelling the health impact of food taxes and subsidies with price elasticities: The case for additional scaling of food consumption using the total food expenditure elasticity. PLoS One 2020; 15:e0230506. [PMID: 32214329 PMCID: PMC7098589 DOI: 10.1371/journal.pone.0230506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Food taxes and subsidies are one intervention to address poor diets. Price elasticity (PE) matrices are commonly used to model the change in food purchasing. Usually a PE matrix is generated in one setting then applied to another setting with differing starting consumptions and prices of foods. This violates econometric assumptions resulting in likely mis-estimation of total food consumption. In this paper we demonstrate this problem, canvass possible options for rescaling all consumption after applying a PE matrix, and illustrate the use of a total food expenditure elasticity (TFEe; the expenditure elasticity for all food combined given the policy-induced change in the total price of food). We use case studies of: NZ$2 per 100g saturated fat (SAFA) tax, NZ$0.4 per 100g sugar tax, and a 20% fruit and vegetable (F&V) subsidy. Methods We estimated changes in food purchasing using a NZ PE matrix applied conventionally, and then with TFEe adjustment. Impacts were quantified for pre- to post-policy changes in total food expenditure and health adjusted life years (HALYs) for the total NZ population alive in 2011 over the rest of their lifetime using a multistate lifetable model. Results Two NZ studies gave TFEe’s of 0.68 and 0.83, with international estimates ranging from 0.46 to 0.90 (except a UK outlier of 0.04). Without TFEe adjustment, total food expenditure decreased with the tax policies and increased with the F&V subsidy–implausible directions of shift given economic theory and the external TFEe estimates. After TFEe adjustment, HALY gains reduced by a third to a half for the two taxes and reversed from an apparent health loss to a health gain for the F&V subsidy. With TFEe adjustment, HALY gains (in 1000’s) were: 1,805 (95% uncertainty interval 1,337 to 2,340) for the SAFA tax; 1,671 (1,220 to 2,269) for the sugar tax; and 953 (453 to 1,308) for the F&V subsidy. Conclusions If PE matrices are applied in settings beyond where they were derived, additional scaling is likely required. We suggest that the TFEe is a useful scalar, but we also encourage other researchers to examine this issue and propose alternative options.
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Affiliation(s)
- Tony Blakely
- Population Interventions Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
- * E-mail:
| | - Nhung Nghiem
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Murat Genc
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Linda Cobiac
- Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Cliona Ni Mhurchu
- National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter Scarborough
- Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Christine Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
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Goiana-da-Silva F, Severo M, Cruz e Silva D, Gregório MJ, Allen LN, Muc M, Morais Nunes A, Torres D, Miraldo M, Ashrafian H, Rito A, Wickramasinghe K, Breda J, Darzi A, Araújo F, Lopes C. Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study. PLoS Med 2020; 17:e1003036. [PMID: 32163412 PMCID: PMC7067376 DOI: 10.1371/journal.pmed.1003036] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal. METHODS AND FINDINGS We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources. CONCLUSIONS The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.
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Affiliation(s)
- Francisco Goiana-da-Silva
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Milton Severo
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - David Cruz e Silva
- Centre for Innovation, Technology and Policy Research, University of Lisbon, Lisbon, Portugal
| | - Maria João Gregório
- Directorate General of Health, Lisbon, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Luke N. Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Magdalena Muc
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Alexandre Morais Nunes
- Centre for Public Administration and Public Policies, Institute of Social and Political Sciences, University of Lisbon, Lisbon, Portugal
| | - Duarte Torres
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Marisa Miraldo
- Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ana Rito
- WHO Collaborating Centre for Nutrition and Childhood Obesity, National Institute of Health (INSA), Lisbon, Portugal
| | - Kremlin Wickramasinghe
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - João Breda
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Fernando Araújo
- University Hospital of São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carla Lopes
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
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Lencucha R, Pal NE, Appau A, Thow AM, Drope J. Government policy and agricultural production: a scoping review to inform research and policy on healthy agricultural commodities. Global Health 2020; 16:11. [PMID: 31959213 PMCID: PMC6971899 DOI: 10.1186/s12992-020-0542-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Unhealthy foods and tobacco remain the leading causes of non-communicable disease (NCDs). These are key agricultural commodities for many countries, and NCD prevention policy needs to consider how to influence production towards healthier options. There has been little scholarship to bridge the agriculture with the public health literature that seeks to address the supply of healthy commodities. This scoping review synthesizes the literature on government agricultural policy and production in order to 1) present a typology of policies used to influence agricultural production, 2) to provide a preliminary overview of the ways that impact is assessed in this literature, and 3) to bring this literature into conversation with the literature on food and tobacco supply.This review analyzes the literature on government agricultural policy and production. Articles written in English and published between January 1997 and April 2018 (20-year range) were included. Only quantitative evaluations were included. Studies that collected qualitative data to supplement the quantitative analysis were also included. One hundred and three articles were included for data extraction. The following information was extracted: article details (e.g., author, title, journal), policy details (e.g., policy tools, goals, context), methods used to evaluate the policy (e.g., outcomes evaluated, sample size, limitations), and study findings. Fifty four studies examined the impact of policy on agricultural production. The remaining articles assessed land allocation (n = 25) (e.g., crop diversification, acreage expansion), efficiency (n = 23), rates of employment including on- and off-farm employment (n = 18), and farm income (n = 17) among others. Input supports, output supports and technical support had an impact on production, income and other outcomes. Although there were important exceptions, largely attributed to farm level allocation of labour or resources. Financial supports were most commonly evaluated including cash subsidies, credit, and tax benefits. This type of support resulted in an equal number of studies reporting increased production as those with no effects.This review provides initial extrapolative insights from the general literature on the impact of government policies on agricultural production. This review can inform dialogue between the health and agricultural sector and evaluative research on policy for alternatives to tobacco production and unhealthy food supply.
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Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Nicole E Pal
- Faculty of Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Adriana Appau
- Research and Evaluation, PolicyWise for Children and Families, Edmonton, Alberta, Canada
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
| | - Jeffrey Drope
- Economic and Health Policy Research, American Cancer Society, Atlanta, USA
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