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Max BL, Mashauri HL. Economic priorities over population health: A political dilemma in addressing noncommunicable diseases in developing countries. Health Sci Rep 2024; 7:e1974. [PMID: 38505686 PMCID: PMC10948585 DOI: 10.1002/hsr2.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024] Open
Abstract
The world is observing a rapid shift in the burden of diseases with predominance of noncommunicable diseases (NCDs). NCDs contribute to 41 million deaths which is equivalent to 74% of all death globally per year. There is ongoing debate on the approaches to reduce public exposure to NCDs' modifiable risk factors which are of economic potential. As the World Health Organization and the World Bank recommend the implementation of taxation to these factors, still questions arise on the effectiveness, sustainability, and practicality of this strategy. With the ongoing transition globally from consumption of natural to processed foods, it is important to counter-check the best interventions on how to protect people from unhealthy eating behaviors. While taxation on unhealthy food and other products like tobacco has been recommended as one among interventional approaches, its effectiveness on sugar sweetened beverages is not reliable compared to approaches that increase self-control. Despite the perceived economic benefits of tobacco and sugar sweetened products, there is detrimental implication in terms of public health. The introduction of taxation which favors public health faces challenges due to conflict of interest from government authorities and other stakeholders. The intertwined relationship between public health and economic development becomes more obvious during implementation of preventive and control measures against modifiable risk factors for NCDs. It is evident that reaching a balanced rational decision on choosing between economic growth and public health is difficult. Countries should enhance both local and international intersectoral and multisectoral approaches in creating integrative policies which include health component in all non-health policies including economic policies so as to harmonize public health and economic growth during this era of extensive globalization.
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Affiliation(s)
- Baraka L. Max
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Health, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Harold L. Mashauri
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Health, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKamanga Medics HospitalMwanzaTanzania
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Balakrishnan M, Rehm J. A public health perspective on mitigating the global burden of chronic liver disease. Hepatology 2024; 79:451-459. [PMID: 37943874 PMCID: PMC10872651 DOI: 10.1097/hep.0000000000000679] [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: 04/14/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
Chronic liver disease is a significant global health problem. Epidemiological trends do not show improvement in chronic liver disease incidence but rather a shift in etiologies, with steatotic liver disease (SLD) from metabolic dysfunction and alcohol becoming increasingly important causes. Consequently, there is a pressing need to develop a comprehensive public health approach for SLD. To that end, we propose a public health framework for preventing and controlling SLD. The framework is anchored on evidence linking physical inactivity, unhealthy dietary patterns, alcohol use, and obesity with both incidence and progression of SLD. Guided by the framework, we review examples of federal/state-level, community-level, and individual-level interventions with the potential to address these determinants of SLD. Ultimately, mitigating SLD's burden requires primary risk factor reduction at multiple socioecological levels, by scaling up the World Health Organization's "best buys," in addition to developing and implementing SLD-specific control interventions.
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Affiliation(s)
- Maya Balakrishnan
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, Canada, M5S 2S1
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, Canada, M5S 2S1
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, Canada, M5T 3M7
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada, M5T 1R8
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Martinistraße 52, Hamburg, 20246, Germany
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Djojosoeparto SK, Poelman MP, Eykelenboom M, Beenackers MA, Steenhuis IHM, van Stralen MM, Olthof MR, Renders CM, van Lenthe FJ, Kamphuis CBM. Do financial constraint and perceived stress modify the effects of food tax schemes on food purchases: moderation analyses in a virtual supermarket experiment. Public Health Nutr 2024; 27:e38. [PMID: 38224250 PMCID: PMC10897579 DOI: 10.1017/s1368980024000077] [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: 02/16/2023] [Revised: 12/07/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To investigate whether financial constraint and perceived stress modify the effects of food-related taxes on the healthiness of food purchases. DESIGN Moderation analyses were conducted with data from a trial where participants were randomly exposed to: a control condition with regular food prices, an sugar-sweetened beverage (SSB) tax condition with a two-tiered levy on the sugar content in SSB (5-8 g/100 ml: €0·21 per l and ≥8 g/100 ml: €0·28 per l) or a nutrient profiling tax condition where products with Nutri-Score D or E were taxed at a 20 percent level. Outcome measures were overall healthiness of food purchases (%), energy content (kcal) and SSB purchases (litres). Effect modification was analysed by adding interaction terms between conditions and self-reported financial constraint or perceived stress in regression models. Outcomes for each combination of condition and level of effect modifier were visualised. SETTING Virtual supermarket. PARTICIPANTS Dutch adults (n 386). RESULTS Financial constraint or perceived stress did not significantly modify the effects of food-related taxes on the outcomes. Descriptive analyses suggest that in the control condition, the overall healthiness of food purchases was lowest, and SSB purchases were highest among those with moderate/high levels of financial constraint. Compared with the control condition, in a nutrient profiling tax condition, the overall healthiness of food purchases was higher and SSB purchases were lower, especially among those with moderate/high levels of financial constraint. Such patterns were not observed for perceived stress. CONCLUSION Further studies with larger samples are recommended to assess whether food-related taxes differentially affect food purchases of subgroups.
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Affiliation(s)
- Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Chair group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Michelle Eykelenboom
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mariëlle A Beenackers
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid HM Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carlijn BM Kamphuis
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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Eykelenboom M, Mersch D, Grasso AC, Vellinga RE, Temme EH, Steenhuis IH, Olthof MR. The effects of health-related food taxes on the environmental impact of consumer food purchases: secondary analysis of data from a randomised controlled trial in a virtual supermarket. Public Health Nutr 2024; 27:e37. [PMID: 38224101 PMCID: PMC10897575 DOI: 10.1017/s1368980024000090] [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: 02/17/2023] [Revised: 11/29/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To measure the effects of health-related food taxes on the environmental impact of consumer food purchases in a virtual supermarket. DESIGN This is a secondary analysis of data from a randomised controlled trial in which participants were randomly assigned to a control condition with regular food prices (n 152), an experimental condition with a sugar-sweetened beverage (SSB) tax (n 131) or an experimental condition with a nutrient profiling tax based on Nutri-Score (n 112). Participants were instructed to undertake their typical weekly grocery shopping for their households. Primary outcome measures were three environmental impact indicators: greenhouse gas (GHG) emissions, land use and blue water use per household per week. Data were analysed using linear regression analyses. SETTING Three-dimensional virtual supermarket. PARTICIPANTS Dutch adults (≥ 18 years) who were responsible for grocery shopping in their household (n 395). RESULTS GHG emissions (-7·6 kg CO2-eq; 95 % CI -12·7, -2·5) and land use (-3·9 m2/year; 95 % CI -7·7, -0·2) were lower for the food purchases of participants in the nutrient profiling tax condition than for those in the control condition. Blue water use was not affected by the nutrient profiling tax. Moreover, the SSB tax had no significant effect on any of the environmental impact indicators. CONCLUSIONS A nutrient profiling tax based on Nutri-Score reduced the environmental impact of consumer food purchases. An SSB tax did not affect the environmental impact in this study.
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Affiliation(s)
- Michelle Eykelenboom
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Derek Mersch
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Alessandra C Grasso
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Reina E Vellinga
- Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Elisabeth Hm Temme
- Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ingrid Hm Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Madurawala S, Kiringoda K, Thow AM, Arunatilake N. Fiscal policies and regulations for healthy diets in Sri Lanka: an analysis of the political economy of taxation and traffic light labelling for sugar-sweetened beverages. Glob Health Action 2023; 16:2280339. [PMID: 38018465 PMCID: PMC10795608 DOI: 10.1080/16549716.2023.2280339] [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: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Unhealthy dietary patterns significantly contribute to rising non-communicable diseases (NCDs) in Sri Lanka. The government has implemented policy measures to promote healthy dietary patterns, including the traffic light labelling (TLL) system for sugar-sweetened beverages (SSBs) in 2016 and taxation on SSBs in 2017. OBJECTIVES To analyse how ideas, institutions, and power dynamics influence the formulation and implementation of these two interventions, and to identify strategies for public health actors to advocate for more effective food environment policies in Sri Lanka. METHODS This study drew on Kingdon's theory of agenda-setting and Campbell's institutionalist approach to develop the theoretical framework. We examined the political economy at the policy development and implementation stages, adopting a deductive framework approach for data collection and analysis. Data were collected from documents and key informants. RESULTS NCDs and nutrition are recognised and framed as important policy issues in health-sector policy documents, and the SSB tax and TLL system are seen as means of improving diets and health. Sri Lanka's commitment to addressing NCDs and nutrition-related issues is evident through these policies. The Ministry of Health led policy development, and key stakeholders were involved. However, there are opportunities to learn and strengthen policy in Sri Lanka and elsewhere. Limited involvement and commitment of some stakeholders in developing national policies, industry interferences, and other gaps resulted in weaker policy design. Gender considerations were also given minimal attention in policy formulation and implementation. CONCLUSIONS To enhance the effectiveness of the policies and regulations to promote healthy diets in Sri Lanka, comprehensive policy coverage, multistakeholder involvement and commitment to national policies, balanced power dynamics, technical feasibility, government commitment backed with high-level political support, awareness, and knowledge creation, managing industry interferences, integrating gender considerations are crucial factors.
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Affiliation(s)
- Sunimalee Madurawala
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
| | - Kimuthu Kiringoda
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Nisha Arunatilake
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
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Walby E, Jones AC, Smith M, Na’ati E, Snowdon W, Teng AM. Food tax policies in Pacific Island Countries and Territories: systematic policy review. Public Health Nutr 2023; 27:e20. [PMID: 38126269 PMCID: PMC10830374 DOI: 10.1017/s1368980023002914] [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: 03/22/2023] [Revised: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To systematically identify and review food taxation policy changes in Pacific Island Countries and Territories (PICTs). DESIGN Food taxation polices, regarding excise taxes and tariffs applied from 2000 to 2020 in twenty-two PICTs, and their key characteristics were reviewed. The search was conducted using databases, government legal repositories and broad-based search engines. Identified documents for screening included legislation, reports, academic literature, news articles and grey literature. Key informants were contacted from each PICT to retrieve further data and confirm results. Results were analysed by narrative synthesis. SETTING Noncommunicable diseases (NCD) are the leading cause of premature death in PICTs and in many jurisdictions globally. An NCD crisis has been declared in the Pacific, and food taxation policy has been recommended to address the dietary risk factors associated with. Progress is unclear. RESULTS Of the twenty-two PICTs included in the study, fourteen had food taxation policies and five introduced excise taxes. Processed foods, sugar and salt were the main target of excise taxes. A total of eighty-four food taxation policy changes were identified across all food groups. There was a total of 279 taxes identified by food group, of which 85 % were tariffs and 15 % were excise taxes. Individual tax rates varied substantially. The predominant tax design was ad valorem, and this was followed by volumetric. CONCLUSIONS A quarter of PICTs have introduced food excise taxes from 2000 to 2020. Further excise taxes, specifically tiered or nutrient-specific designs, could be introduced and more systematically applied to a broader range of unhealthy foods.
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Affiliation(s)
- Emilee Walby
- University of Otago Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand
| | | | - Moira Smith
- University of Otago Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand
| | | | - Wendy Snowdon
- Globe Centre for Preventive Health and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Andrea M Teng
- University of Otago Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand
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Nabyonga-Orem J, Christmals CD, Addai KF, Mwinga K, Karenzi-Muhongerwa D, Namuli S, Asamani JA. The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review. J Glob Health 2023; 13:04153. [PMID: 37962340 PMCID: PMC10644850 DOI: 10.7189/jogh.13.04153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Background Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation. Methods We conducted a systematic scoping review of the literature to analyze the nature, type, and factors impacting the implementation of innovative health financing mechanisms in the World Health Organization (WHO) African region. Results Innovative health financing mechanisms are increasing in the WHO African region as a result of international policy, the need to improve healthy eating and social life of the populace, advocacy and the availability of international mechanisms to which countries can subscribe. The 41 documents included in this review reported ten innovative financing mechanisms in 43 out of the 47 WHO Africa region member states. The most common mechanisms include an excise tax on tobacco products (43 countries) and alcoholic beverages and spirits (41 countries), airline ticket levy (18 countries), sugar-based beverages tax (seven countries), and levy on oil, gas and mineral tax (four countries). Other mechanisms include the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) trust fund, the social impact bond, the financial transaction tax, mobile phone tax and equity funds. Funds generated from many mechanisms are not allocated to health, although some portions are allocated to health-related activities. In some countries where mechanisms implemented are public health-related, emphasis is placed on positive health behavior beyond raising funds. Persistent resistance from industries due to conflicting economic policies is a major challenge. Conclusions Leveraging international policies and setting up intersectoral committees to develop and implement innovative mechanisms that involve excise taxes are recommended as possible solutions to the conflicts of interest.
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Affiliation(s)
- Juliet Nabyonga-Orem
- World Health Organization Regional office for Africa, Office of the Regional Director, Brazzaville, Congo
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Christmal D Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Kingsley F Addai
- World Health Organization Ghana country office, Universal Health Coverage Life Course Cluster, Accra, Ghana
| | - Kasonde Mwinga
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Diane Karenzi-Muhongerwa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Sylvia Namuli
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - James A Asamani
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
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Buksh SM, Crookes A, de Wit JBF. Effectiveness of NCD-Related Fiscal Policies: Evidence from the Pacific. Nutrients 2023; 15:4669. [PMID: 37960321 PMCID: PMC10647377 DOI: 10.3390/nu15214669] [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: 09/13/2023] [Revised: 10/20/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Obesity in Pacific Island countries (PICs) has hit crisis levels, and the consequent high non-communicable disease (NCD) burden is devastating for their developing economies. Nutrition transitions from traditional, plant and seafood diets to a dependence on processed foods are at the core of the obesity and NCD epidemic in PICs. Fiscal policies are widely promoted as an effective mechanism to reduce consumption of unhealthy foods and increase consumption of fruits and vegetables. However, there are little data to evaluate the effectiveness of these policies as rates of NCDs and obesity in PICs continue to rise. This study used an online survey to recruit 4116 adults from six PICs: Fiji, Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu. The study measured the consumption of and household access to sugar-sweetened beverages, ultra-processed packaged snacks, fruits and vegetables and attitudes on food prices and unhealthy eating. The study also assessed the relationship between consumption of these foods and drink and (1) household access, (2) price as a food choice motive, and (3) unhealthy eating attitudes. This study provides novel data on food-related behaviours in PICs, offers insights into the potential impact of NCD-related fiscal policies on food consumption and identifies other variables of interest.
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Affiliation(s)
- Shazna M. Buksh
- School of Law and Social Sciences, The University of the South Pacific, Suva 1168, Fiji; (S.M.B.); (A.C.)
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Science, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Annie Crookes
- School of Law and Social Sciences, The University of the South Pacific, Suva 1168, Fiji; (S.M.B.); (A.C.)
| | - John B. F. de Wit
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Science, Utrecht University, 3584 CS Utrecht, The Netherlands
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Alvarado M, Adams J, Penney T, Murphy MM, Abdool Karim S, Egan N, Rogers NT, Carters-White L, White M. A systematic scoping review evaluating sugar-sweetened beverage taxation from a systems perspective. NATURE FOOD 2023; 4:986-995. [PMID: 37857862 PMCID: PMC10661741 DOI: 10.1038/s43016-023-00856-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/08/2023] [Indexed: 10/21/2023]
Abstract
Systems thinking can reveal surprising, counterintuitive or unintended reactions to population health interventions (PHIs), yet this lens has rarely been applied to sugar-sweetened beverage (SSB) taxation. Using a systematic scoping review approach, we identified 329 papers concerning SSB taxation, of which 45 considered influences and impacts of SSB taxation jointly, involving methodological approaches that may prove promising for operationalizing a systems informed approach to PHI evaluation. Influences and impacts concerning SSB taxation may be cyclically linked, and studies that consider both enable us to identify implications beyond a predicted linear effect. Only three studies explicitly used systems thinking informed methods. Finally, we developed an illustrative, feedback-oriented conceptual framework, emphasizing the processes that could result in an SSB tax being increased, maintained, eroded or repealed over time. Such a framework could be used to synthesize evidence from non-systems informed evaluations, leading to novel research questions and further policy development.
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Affiliation(s)
- Miriam Alvarado
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK.
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Tarra Penney
- Global Food System and Policy Research, School of Global Health, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Madhuvanti M Murphy
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | | | - Nat Egan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Nina Trivedy Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Lauren Carters-White
- SPECTRUM Consortium, Usher Institute of Population Health Sciences and Informatics, Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
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Mukanu MM, Thow AM, Delobelle P, Mchiza ZJR. Mapping of food environment policies in Zambia: a qualitative document analysis. BMC Nutr 2023; 9:112. [PMID: 37784146 PMCID: PMC10544488 DOI: 10.1186/s40795-023-00766-1] [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: 09/15/2022] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The food environment in which people exercise food choices significantly impacts their dietary patterns. Policies that limit the availability, affordability, and access to unhealthy food while increasing that of healthier alternatives help build healthy food environments, which are required to address the double burden of malnutrition. This study aimed to assess the availability of food environment policies in Zambia. METHOD We applied a two-step qualitative document analysis to identify policy content relating to healthy food environments from global and Zambia-specific nutrition-related policy documents. In the first step, global policy documents were analyzed to develop a reference point for globally recommended policies for healthy food environments. In the second step, Zambia's nutrition-related policies were analyzed to identify content relating to healthy food environments. The identified policy content was then mapped against the global reference point to identify food environment policy gaps. RESULTS Our analysis of global policy recommendations identified five broad categories of policy provisions: information and education based; regulatory and legislative tools; strategies to promote production and access to healthy food production; social protection-based strategies and guiding principles for governments relating to multisectoral collaboration and governance. Our analysis found that Zambian Government policy documents in the health, agriculture, education, and national planning and development sectors have policy provisions for healthy food environments. While these policy provisions generally covered all five reference categories, we found policy gaps in the regulatory and legislative tools category relative to global recommendations. CONCLUSION Zambia's food environment policy landscape must include globally recommended regulatory and legislative policy measures like restricting the marketing of unhealthy foods and non-alcoholic beverages to children. Nutrition policy reforms are required to facilitate the introduction of regulatory and legislative policy measures that effectively address the double burden of malnutrition in Zambia.
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Affiliation(s)
- Mulenga Mary Mukanu
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, 7700, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, 7505, South Africa
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Lwin KS, Koon AD, Rasanathan K, Ahsan A, Erku D, Mialon M, Perez-Leon S, Singh A, Mirza Z, Zuleta M, Adhikari SR, Acharya Y, Dao ST, Rasheed S, Paul J, Marten R. Framing health taxes: learning from low- and middle-income countries. BMJ Glob Health 2023; 8:e012955. [PMID: 37832966 PMCID: PMC10583086 DOI: 10.1136/bmjgh-2023-012955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/27/2023] [Indexed: 10/15/2023] Open
Abstract
Health taxes are effective policy instruments to save lives, raise government revenues and improve equity. Health taxes, however, directly conflict with commercial actors' interests. Both pro-tax health advocates and anti-tax industry representatives seek to frame health tax policy. Yet, little is known about which frames resonate in which settings and how framing can most effectively advance or limit policies. To fill this gap, we conducted qualitative research in 2022, including focus group discussions, in-depth interviews, document reviews and media analysis on the political economy of health taxes across eight low-income and middle-income countries. Studies captured multiple actors constructing context-specific frames, often tied to broader economic, health and administrative considerations. Findings suggest that no single frame dominates; in fact, a plurality of different frames exist and shape discourse and policymaking. There was no clear trade-off between health and economic framing of health tax policy proposals, nor a straightforward way to handle concerns around earmarking. Understanding how to best position health taxes can empower health policymakers with more persuasive framings for health taxes and can support them to develop broader coalitions to advance health taxes. These insights can improve efforts to advance health taxes by better appreciating political economy factors and constraining corporate power, ultimately leading to improved population-level health.
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Affiliation(s)
- Kaung Suu Lwin
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Abdillah Ahsan
- Department of Economics, Facutly of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Daniel Erku
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Centre for Applied Health Economics, Griffith University, Gold Coast, Queensland, Australia
| | | | - Silvana Perez-Leon
- CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Arti Singh
- School of Public Health, KNUST, Kumasi, Ghana
| | - Zafar Mirza
- School of Universal Health Coverage, Shifa Tameer-i-Millat University, Islamabad, Pakistan
| | | | | | - Yubraj Acharya
- Department of Health Policy & Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Sabrina Rasheed
- Health Systems and Population Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jeremias Paul
- Fiscal Policies for Health Unit, Department of Health Promotion, WHO Secretariat, Geneva, Switzerland
| | - Robert Marten
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
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12
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Koon AD, Marten R. Framing health taxes: a scoping review. BMJ Glob Health 2023; 8:e012055. [PMID: 37813439 PMCID: PMC10565303 DOI: 10.1136/bmjgh-2023-012055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/06/2023] [Indexed: 10/13/2023] Open
Abstract
Health taxes are increasingly positioned as effective policy instruments for curbing non-communicable disease, improving health and raising government revenues. Their allure has caused many health advocates to look beyond tobacco and alcohol to other harmful products such as sugar-sweetened beverages (SSBs), salty foods, fatty foods and fossil fuels. These efforts, however, directly conflict with commercial actors' interests. Both pro-tax health advocates and anti-tax industry representatives seek to frame health tax policy in favourable ways. Yet, little is known about which types of frames resonate in which settings, or how they deploy morals and values in their attempts to persuade. To fill this gap, we conducted a scoping review on framing health taxes using six databases in 2022. A total of 40 peer-reviewed empirical research articles, from 2006 to 2022, were identified from 20 different countries. Most research was conducted in high-income countries, published in the last 4 years and increasingly focused on excise taxes for SSBs. Studies captured multiple actors constructing context-specific frames, often tied to broader economic, health and administrative considerations. Actors also engaged in a range of political activities in addition to framing. We found some evidence that anti-tax framing strategies potentially incorporated a broader array of morals and social values. More in-country comparative research, particularly from low/middle-income countries, is needed to understand the politics of framing health taxes. We argue that these insights can improve efforts to advance health taxes by constraining corporate power, improving population level health and promoting greater social harmony.
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Affiliation(s)
- Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert Marten
- Secretariat, WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
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13
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Reeve E, Ravuvu A, Johnson E, Nasiga S, Brewer T, Mounsey S, Thow AM. Scaling up food pricing policies in the Pacific: a guide to action. BMJ Glob Health 2023; 8:e012041. [PMID: 37813442 PMCID: PMC10565307 DOI: 10.1136/bmjgh-2023-012041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/21/2023] [Indexed: 10/13/2023] Open
Abstract
There are calls for governments around the world to adopt pricing policies, including taxes, subsidies and price controls that ensure all people have access to, and can afford, healthy diets. Despite the strong potential of pricing policies to promote healthy diets and to support a post-COVID-19 recovery, there are gaps in evidence with regard to 'how' to design and apply effective food taxes in practice, and countries report challenges in navigating the different policy options.In this practice piece, we examine the global evidence for food taxes with a view to identifying practical lessons for policy design, adoption and implementation, using the Pacific Islands Region as a case study. We present a systematic resource that draws on locally generated evidence, and a Pacific conceptualisation of healthy diets, to address considerations in setting the tax base, rate and mechanisms, and to ensure tax targets are clearly identifiable within national tax and administrative systems. Health and Finance collaboration at the country level could ensure tax design addresses concerns for the impacts of food taxes on employment, economics and equity, as well as position food taxes as an opportunity to fund revenue shortfalls faced by governments following the COVID-19 pandemic. We demonstrate a need to review other policies for consistency with national health objectives to ensure that countries avoid inadvertently undermining health taxes, for example, by ensuring that foods with known non-communicable disease risk are not being price protected or promoted.
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Affiliation(s)
- Erica Reeve
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Amerita Ravuvu
- Non-Communicable Disease (NCD) Prevention and Control Programme, Public Health Division, Pacific Community, Suva, Fiji
| | - Ellen Johnson
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
| | - Selai Nasiga
- Independent consultant, Commonwealth Secretariat, London, UK
| | - Tom Brewer
- Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sarah Mounsey
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
| | - Anne Marie Thow
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
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14
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Barry LE, Kee F, Woodside J, Cawley J, Doherty E, Clarke M, Crealey GE, Duggan J, O’Neill C. An umbrella review of the acceptability of fiscal and pricing policies to reduce diet-related noncommunicable disease. Nutr Rev 2023; 81:1351-1372. [PMID: 36857083 PMCID: PMC10494142 DOI: 10.1093/nutrit/nuad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
CONTEXT Poor diet has been implicated in a range of noncommunicable diseases. Fiscal and pricing policies (FPs) may offer a means by which consumption of food and non-alcoholic beverages with links to such diseases can be influenced to improve public health. OBJECTIVE To examine the acceptability of FPs to reduce diet-related noncommunicable disease, based on systematic review evidence. DATA SOURCES MEDLINE, EMBASE, PsychInfo, SCI, SSCI, Web of Science, Scopus, EconLit, the Cochrane Library, Epistemonikos, and the Campbell Collaboration Library were searched for relevant studies published between January 1, 1990 and June 2021. DATA EXTRACTION The studies included systematic reviews of diet-related FPs and: used real-world evidence; examined real or perceived barriers/facilitators; targeted the price of food or non-alcoholic beverages; and applied to entire populations within a jurisdiction. A total of 9996 unique relevant records were identified, which were augmented by a search of bibliographies and recommendations from an external expert advisory panel. Following screening, 4 systematic reviews remained. DATA ANALYSIS Quality appraisal was conducted using the AMSTAR 2 tool. A narrative synthesis was undertaken, with outcomes grouped according to the WHO-INTEGRATE criteria. The findings indicated a paucity of high-quality systematic review evidence and limited public support for the use of FPs to change dietary habits. This lack of support was related to a number of factors that included: their perceived potential to be regressive; a lack of transparency, ie, there was mistrust around the use of revenues raised; a paucity of evidence around health benefits; the deliberate choice of rates that were lower than those considered necessary to affect diet; and concerns about the potential of such FPs to harm economic outcomes such as employment. CONCLUSION The findings underscore the need for high-quality systematic review evidence on this topic, and the importance of responding to public concerns and putting in place mechanisms to address these when implementing FPs. This study was funded by Safefood [02A-2020]. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021274454.
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Affiliation(s)
- Luke E Barry
- Centre for Public Health, Queen’s University, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen’s University, Belfast, United Kingdom
| | - Jayne Woodside
- Centre for Public Health, Queen’s University, Belfast, United Kingdom
| | - John Cawley
- Brooks School of Public Policy, Cornell University, Ithaca, New York, USA
| | - Edel Doherty
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, County Galway, Ireland
| | - Mike Clarke
- Centre for Public Health, Queen’s University, Belfast, United Kingdom
| | - Grainne E Crealey
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, County Galway, Ireland
| | - Jim Duggan
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, County Galway, Ireland
| | - Ciaran O’Neill
- Centre for Public Health, Queen’s University, Belfast, United Kingdom
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15
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Klink U, Härtling V, Schüz B. Perspectives on Healthy Eating of Adult Populations in High-Income Countries: A Qualitative Evidence Synthesis. Int J Behav Med 2023:10.1007/s12529-023-10214-w. [PMID: 37670167 DOI: 10.1007/s12529-023-10214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Understanding how individuals currently perceive healthy eating is essential for developing food policies and dietary recommendations that improve the health and well-being of populations. The purpose of this qualitative evidence synthesis was to systematically outline the views and understandings of healthy eating, focusing on how foods are classified as healthy and unhealthy and what meanings are attached to food and eating by the general adult population in high-income countries. METHODS A systematic search of four electronic databases was conducted and yielded 24 relevant primary qualitative studies of generally healthy, community-dwelling adults. RESULTS Thematic synthesis of the included studies identified three analytic themes: constructions of healthy and unhealthy eating, considerations on dietary recommendations, and meanings attached to food and eating. Study participants generally understood what constitutes a healthy and unhealthy diet which was in line with dietary recommendations, but those of lower socioeconomic status exhibited gaps in nutrition knowledge. Participants expressed diverse opinions on dietary recommendations, including skepticism and a lack of trust. Food and eating were associated with various meanings, including pleasure, stress relief, and feelings of guilt. Moral, health, and sociocultural considerations also played a role in dietary behaviors. CONCLUSIONS The findings suggest that improving population diet requires considering how dietary recommendations are phrased and communicated to ensure that healthy eating is associated with pleasure and immediate well-being. This review provides valuable insights for developing consumer-oriented, practicable, and acceptable food policies and dietary recommendations that effectively improve population health and well-being.
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Affiliation(s)
- Urte Klink
- Department of Prevention and Health Promotion, Institute for Public Health and Nursing Research, University of Bremen, Bremen, 28359, Germany.
| | - Victoria Härtling
- Department of Prevention and Health Promotion, Institute for Public Health and Nursing Research, University of Bremen, Bremen, 28359, Germany
| | - Benjamin Schüz
- Department of Prevention and Health Promotion, Institute for Public Health and Nursing Research, University of Bremen, Bremen, 28359, Germany
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16
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Liu S, Ohinmaa A, Maximova K, Veugelers PJ. The health and economic benefits of sugar taxation and vegetables and fruit subsidy scenarios in Canada. Soc Sci Med 2023; 329:116012. [PMID: 37331286 DOI: 10.1016/j.socscimed.2023.116012] [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: 02/23/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
A tax on sugar-sweetened beverages (SSB) has been implemented in various jurisdictions. Though research confirmed this tax to reduce sugar consumption and to prevent chronic diseases, it also revealed concerns: one concern relates to the small proportion of sugar in the diet coming from SSBs; and another concern relates to the disproportional tax burden to low-income groups. To inform public health decision makers on alternatives, we examined three 'real world' taxation and subsidy scenarios in Canada: 1) a CAD$0.75/100 g tax on SSBs; 2) a CAD$0.75/100 g tax on free sugar in all foods; and 3) a 20% subsidy on vegetables and fruit (V&F). Using national survey data and a proportional multi-state life table-based Markov model, we simulated the changes in disability-adjusted life years, healthcare costs, tax revenue, intervention costs, and incremental cost-effectiveness ratio for five income quintiles after implementing the three scenarios, over a lifetime of the 2015 Canadian adult population. The first, second and third scenario would prevent 28,921, 262,348 and 551 cases of type 2 diabetes, respectively. They would avert 752,353, 12,167,113, and 29,447 disability-adjusted life years and save CAD$12,942 million, 149,927 million, and 442 million in health care costs, respectively, over a lifetime. Combining the second and third scenarios would lead to the largest health and economic benefits. Although the lowest income quintile would bear a higher sugar tax burden (0.81% of income, CAD$120/person/year), this would be compensated by a coinciding subsidy on V&F (1.30% of income, CAD$194/person/year). These findings support policies that include a tax on all free sugar in foods and a subsidy on V&F as an effective means to reduce chronic diseases and health care costs. Although the sugar tax was financially regressive, the V&F subsidy could compensate for the tax burden of the disadvantaged groups and improve health and economic equity.
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Affiliation(s)
- Siyuan Liu
- Population Development Studies Center, Institute of Health Science, School of Sociology and Population Studies, Renmin University of China, Beijing, China; Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, T6G 2T4, Canada
| | - Arto Ohinmaa
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, T6G 2T4, Canada.
| | - Katerina Maximova
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, T6G 2T4, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul J Veugelers
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, T6G 2T4, Canada
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17
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Singh A, Smith K, Hellowell M, Logo DD, Marten R, Suu K, Owusu-Dabo E. An exploration of stakeholder views and perceptions on taxing tobacco, alcohol and sugar-sweetened beverages in Ghana. BMJ Glob Health 2023; 8:e012054. [PMID: 37257939 PMCID: PMC10255295 DOI: 10.1136/bmjgh-2023-012054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) account for nearly 43% of Ghana's all-cause mortality. Unhealthy commodities (such as alcohol, sugar and tobacco) are an important factor in the growing NCD burden in the region of sub-Saharan Africa (SSA). Despite health taxes on tobacco, alcohol and sugar-sweetened beverages (SSBs) gaining renewed attention, adoption and implementation in SSA remain limited. This study aims to unpack the contextual politics and to examine current perceptions of opportunities and barriers for health taxes in Ghana. METHODS Semistructured qualitative interviews (n=19) conducted with purposively sampled stakeholders representing four sectors: government, civil society, media and international organisations, and two group interviews with nine industry stakeholders, informed by a review of relevant literature and policy/advocacy documents. RESULTS Stakeholders had a general belief that such taxes are primarily useful for revenue generation (for health spending) rather than for reducing consumption and improving health. There do appear to be opportunities for health taxes with stakeholders broadly supportive of taxing SSBs. This support could be strengthened via 'health' framing of any new tax proposals, the generation of Ghana-specific evidence about the potential impacts of such taxes and greater public awareness. Industry actors and some government representatives opposed health taxes, citing concerns about the potential to increase illicit trade and economic harm. Some stakeholders also believed that links between politicians and affected industries represent an important barrier. CONCLUSION These findings identify opportunities to introduce health taxes but also underline the potential resistance from affected industry stakeholders. Nevertheless, a strategic approach that focuses on achieving policy coherence (between central government, health and economic ministries), combined with efforts to strengthen stakeholder and public support, may weaken the lobbying position of industry. Such efforts could be supported by research to help demonstrate the value of different designs of health taxes for achieving Ghana's health goals and to better understand industry-political links.
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Affiliation(s)
- Arti Singh
- School of Public Health, KNUST, Kumasi, Ghana
| | - Katherine Smith
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Mark Hellowell
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | | | - Robert Marten
- WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Kaung Suu
- Alliance For Health Policy and System Research, Geneva, Switzerland
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18
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Barry LE, Kee F, Woodside J, Clarke M, Cawley J, Doherty E, Crealey GE, Duggan J, O'Neill C. An umbrella review of the effectiveness of fiscal and pricing policies on food and non-alcoholic beverages to improve health. Obes Rev 2023:e13570. [PMID: 37095626 DOI: 10.1111/obr.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/03/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
Poor quality diets represent major risk factors for the global burden of disease. Modeling studies indicate a potential for diet-related fiscal and pricing policies (FPs) to improve health. There is real-world evidence (RWE) that such policies can change behavior; however, the evidence regarding health is less clear. We conducted an umbrella review of the effectiveness of FPs on food and non-alcoholic beverages in influencing health or intermediate outcomes like consumption. We considered FPs applied to an entire population within a jurisdiction and included four systematic reviews in our final sample. Quality appraisal, an examination of excluded reviews, and a literature review of recent primary studies assessed the robustness of our results. Taxes and, to some extent, subsidies are effective in changing consumption of taxed/subsidized items; however, substitution is likely to occur. There is a lack of RWE supporting the effectiveness of FPs in improving health but this does not mean that they are ineffective. FPs may be important for improving health but their design is critical. Poorly designed FPs may fail to improve health and could reduce support for such policies or be used to support their repeal. More high-quality RWE on the impact of FPs on health is needed.
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Affiliation(s)
- Luke E Barry
- Centre for Public Health, Queen's University Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, UK
| | - Jayne Woodside
- Centre for Public Health, Queen's University Belfast, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, UK
| | - John Cawley
- Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
| | - Edel Doherty
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Grainne E Crealey
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Jim Duggan
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, UK
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19
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Problems and Solutions of Taxation to Control Unhealthy Goods: A Qualitative Study. HEALTH SCOPE 2023. [DOI: 10.5812/jhealthscope-132036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
Background: Taxes on unhealthy goods, in addition to reducing the consumption of these goods, preventing related diseases, and promoting public health, can provide significant financial resources for the health sector. Objectives: The purpose of this study was to investigate the problems and solutions of taxation to control the consumption of unhealthy goods to improve public health. Methods: This qualitative study was conducted in 2021. Semi-structured interviews with open-ended questions were held to collect information. Sampling was performed by purposive and snowball methods with 31 managers and key experts. The data were analyzed using the content analysis method. MAXQDA software (version 12) was used for classification and coding. Results: This study labeled 2 main themes and 10 subthemes. The main themes included problems of controlling unhealthy goods and solutions to controlling unhealthy goods. Poor decision-making, planning, and execution, production-related problems, smuggling and poor supervision, increased consumption of harmful goods, conflicts of interest, and advertisements of unhealthy goods are the most important of these problems. Imposing taxes, duties, and price hikes, providing alternatives, paying attention to all determinants of supply and demand, and taxation on advertising are also solutions to control unhealthy products. Conclusions: The health level of individuals should be improved by imposing taxes on unhealthy goods, determining accurate tax rates, and simultaneously using measures, such as providing alternatives to unhealthy goods and controlling advertisements. Paying serious attention to the list of harmful goods, coordination and cooperation of related organizations in formulating and implementing tax policies, and providing suitable alternatives to harmful products are the practical suggestions of this study.
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20
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Mauli S, Thow AM, Mulcahy G, Andrew G, Ride A, Tutuo J. Opportunities to Strengthen Fish Supply Chain Policy to Improve External Food Environments for Nutrition in the Solomon Islands. Foods 2023; 12:foods12040900. [PMID: 36832974 PMCID: PMC9956379 DOI: 10.3390/foods12040900] [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: 11/22/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Malnutrition and food insecurity have significant social and economic impacts in small island developing states, such as the Solomon Islands. Enhancing the domestic supply of fish, the main source of local protein, can contribute to improved nutrition and food security. This research aimed to improve understanding of the policy interface between the fisheries and health sectors and identify opportunities to strengthen fish supply chain policy to improve domestic (particularly urban) access to fish in the Solomon Islands. The study design drew on theories of policy learning and policy change and analysed policies using a consumption-oriented supply chain approach. Interviews were conducted with 12 key informants in the Solomon Islands, and 15 policy documents were analysed. Analysis of policy documents and interview data indicated that there were strengths as well as opportunities in the existing policy context. In particular, community-based fisheries management approaches and explicit recognition of the links between fisheries and nutrition were key strengths. Challenges included gaps in implementation, variations in capacities across government actors and communities, and limited attention to domestic monitoring and enforcement. Improving the effectiveness of resource management efforts may result in sustainable outcomes for both livelihoods and health, which will accomplish priorities at the national and sub-national levels and support the achievement of the Solomon Islands' commitments to the Sustainable Development Goals.
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Affiliation(s)
- Senoveva Mauli
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW 2500, Australia
- Correspondence:
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, Charles Perkins Centre D17, University of Sydney, Sydney, NSW 2006, Australia
| | - Georgina Mulcahy
- Menzies Centre for Health Policy and Economics, Charles Perkins Centre D17, University of Sydney, Sydney, NSW 2006, Australia
| | - Grace Andrew
- Menzies Centre for Health Policy and Economics, Charles Perkins Centre D17, University of Sydney, Sydney, NSW 2006, Australia
| | - Anouk Ride
- WorldFish, Honiara P.O. Box 438, Solomon Islands
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21
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Paraje G, Montes de Oca D, Corvalán C, Popkin B. Socioeconomic Patterns in Budget Share Allocations of Regulated Foods and Beverages in Chile: A Longitudinal Analysis. Nutrients 2023; 15:nu15030679. [PMID: 36771386 PMCID: PMC9920097 DOI: 10.3390/nu15030679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Chile has enacted stringent legislation regulating food and beverage labeling and advertising. This study assesses the changes in the average relative allocations of food and beverage budgets for regulated versus not regulated products in households of different socioeconomic and demographic backgrounds. A household fixed effect before-after model is estimated and the marginal effects in the changes of levels and trends in budget shares and purchased volumes after the implementation of the regulations are examined. The results highlight how impactful food policies can shift consumption toward healthier products.
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Affiliation(s)
- Guillermo Paraje
- School of Business, Universidad Adolfo Ibáñez, Avenida Diag Las Torres 2640, Santiago 7941169, Chile
- Correspondence: ; Tel.: +56-2-2331-1380
| | - Daniela Montes de Oca
- Instituto de Nutriciόn y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago 7830490, Chile
| | - Camila Corvalán
- Instituto de Nutriciόn y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago 7830490, Chile
| | - Barry Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, 123 W Franklin St, Suite 210, CB 8120, Chapel Hill, NC 27516, USA
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22
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Kooshkebaghi M, Dargahi H, Emamgholipour S. The role of taxation measures in the management of harmful products, services, and practices in Iran: a qualitative study. BMC Public Health 2022; 22:2307. [PMID: 36494705 PMCID: PMC9733354 DOI: 10.1186/s12889-022-14673-w] [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: 09/21/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIM Levying a tax on harmful products, services, and practices can affect consumer choices, effectively preventing diseases and reducing health care costs. The goal of this study was to investigate the role of taxation as a powerful financial tool in the management of harmful products, services, and practices to maintain and improve public health and preserve the financial sustainability of the health care system. MATERIALS AND METHODS This qualitative study was conducted in 2020-2021. In order to collect information for this study, semi-structured interviews were conducted. Using purposive and snowball sampling methods, 38 managers, policymakers, economists, and key experts were interviewed. Data were analyzed using the content analysis method. The transcribed interviews were further imported into MAXQDA for classification, and relevant codes were extracted. FINDINGS In this study, 6 main themes and 19 subthemes were labeled. The main themes included 1) objectives, effects, and requirements of the taxation of harmful products, services, and practices, 2) definition, instances, elasticity, and grading of harmful products, services, and practices, 3) Problems in controlling harmful products, services, and practices, 4) controlling harmful products, services, and practices, 5) traffic violations and accidents, and social harms, and 6) tax revenue use and the share of health care. The effects of taxing harmful products include reduced access to these products, reduced demand for harmful products, and the promotion of public health. CONCLUSION Harmful products, services, and practices have major health and financial implications for individuals, families, and society. To improve public health, the demand for these products and services can be controlled through taxation measures to push consumers toward less harmful alternatives.
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Affiliation(s)
- Mahdi Kooshkebaghi
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Dargahi
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Emamgholipour
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Liu Z, Li S, Peng J. Exploring the Relationship between Sugar and Sugar Substitutes-Analysis of Income Level and Beverage Consumption Market Pattern Based on the Perspective of Healthy China. Nutrients 2022; 14:4474. [PMID: 36364736 PMCID: PMC9657880 DOI: 10.3390/nu14214474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 02/08/2024] Open
Abstract
This paper estimates the impact of income level on household beverage consumption, analyzes the consumption trends of sugar-sweetened beverages and sugar-free beverages in households, explores the future changes in the beverage consumption market pattern, and predicts the possible impact of the sugar industry on the development of sugar substitutes based on the beverage consumption data of Kantar Consumer Index in China from 2015 to 2017. The research results show that, firstly, there is an "inverted U-shaped" relationship between income level and household consumption of sugar-sweetened beverages, which indicates that as income rises, household consumption of sugar-sweetened beverages tends to increase and then decrease. Secondly, income level has a positive effect on the household consumption of sugar-free beverages. Finally, in the future stage, with the further growth of income and the promotion of a healthy China, a large amount of sugar substitutes will be added to beverages instead of the original sugar, and the relationship between sugar and sugar substitute consumption will change from complementary to substitution. The findings of this paper have implications for encouraging food and beverage suppliers to produce "healthy", "nutritious" and "innovative" low-sugar products to meet the health needs of residents and ensure the healthy and orderly development of the sugar industry.
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Affiliation(s)
- Zeqi Liu
- China Institute for Rural Studies, School of Public Policy & Management, Tsinghua University, Beijing 100084, China
| | - Shanshan Li
- National Agricultural and Rural Development Research Institute, College of Economics and Management, China Agricultural University, Beijing 100083, China
| | - Jiaqi Peng
- National Agricultural and Rural Development Research Institute, College of Economics and Management, China Agricultural University, Beijing 100083, China
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Fernández-Escobar C, Díez J, Martínez-García A, Bilal U, O'Flaherty M, Franco M. Food availability and affordability in a Mediterranean urban context: associations by store type and area-level socio-economic status. Public Health Nutr 2022; 26:1-9. [PMID: 36274648 DOI: 10.1017/s1368980022002348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although food environments have been highlighted as potentially effective targets to improve population diets, evidence on Mediterranean food environments is lacking. We examined differences in food availability and affordability in Madrid (Spain) by store type and area-level socio-economic status (SES). DESIGN Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool to measure the availability and price of twelve food groups (specific foods = 35). We computed NEMS-S-MED scores and summarised price data with a Relative Price Index (RPI, comparing prices across stores) and an Affordability Index (normalising prices by area-level income). We compared the availability and affordability of 'healthier-less healthy' food pairs, scores between food store types (supermarkets, specialised, convenience stores and others) and area-level SES using ANOVA and multi-level regression models. SETTING City of Madrid. 2016 and 2019 to cover a representative sample. PARTICIPANTS Food stores within a socio-economically diverse sample of sixty-three census tracts (n 151). RESULTS Supermarkets had higher food availability (37·5/49 NEMS-S-MED points), compared to convenience stores (13·5/49) and specialised stores (8/49). Supermarkets offered lower prices (RPI: 0·83) than specialised stores (RPI: 0·97) and convenience stores (RPI: 2·06). Both 'healthy' and 'less healthy' items were more available in supermarkets. We found no differences in food availability or price by area-level SES, but affordability was higher in higher-income areas. CONCLUSIONS Supermarkets offered higher food availability and affordability for healthy and less healthy food items. Promoting healthy food availability through supermarkets and specialised stores and/or limiting access to convenience stores are promising policy options to achieve a healthier food environment.
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Affiliation(s)
- Carlos Fernández-Escobar
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Alba Martínez-García
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690Alicante, Spain
| | - Usama Bilal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Manuel Franco
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kusama T, Nakazawa N, Takeuchi K, Kiuchi S, Osaka K. Free Sugar Intake and Periodontal Diseases: A Systematic Review. Nutrients 2022; 14:nu14214444. [PMID: 36364708 PMCID: PMC9656760 DOI: 10.3390/nu14214444] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023] Open
Abstract
High free sugar intake is associated with an increased risk of various non-communicable diseases. We aimed to systematically review articles investigating the association between free sugar intake and periodontal diseases. This systematic review was conducted according to PRISMA guidelines and was registered in the PROSPERO database (CRD42022337828). We obtained articles from PubMed, Web of Science, and Scopus in April 2022. The study selection was performed according to predefined eligibility criteria based on the following PECOS: (P) general population, (E/C) free-sugar-containing food/beverage intake, (O) clinically measured periodontal diseases, and (S) observational study and clinical trial. Of the 839 screened records, 13 studies were included in the review. Most studies (n = 12) had a cross-sectional design. The age groups in the included studies were children/adolescents (n = 5) and adults (n = 8). Among the included studies, 11 reported a significant association between the frequent intake of free-sugar-containing food or beverages and a higher prevalence or incidence of periodontal diseases. The quality of most of the included studies was scored "fair" based on the Newcastle-Ottawa Quality Assessment Scale. Although the majority of the included studies reported a significant positive association between high free sugar intake and periodontal diseases, the evidence is considered to be limited due to the study designs.
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Affiliation(s)
- Taro Kusama
- Division for Regional Community Development, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
- Correspondence: ; Tel.: +81-22-717-7639
| | - Noriko Nakazawa
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
| | - Kenji Takeuchi
- Division for Regional Community Development, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
| | - Sakura Kiuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
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Williams S, Hill SE, Oyebode O. 'Choice should be made through… educated decisions not regressive dictates': discursive framings of a proposed 'sugar tax' in Bermuda: analysis of submissions to a government consultation. Global Health 2022; 18:89. [PMID: 36271432 PMCID: PMC9587584 DOI: 10.1186/s12992-022-00877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Several governments have introduced taxes on products with high sugar content as part of their obesity prevention strategies. Bermuda is the first jurisdiction to apply such measures in the Caribbean – a region of small island developing states and territories with high obesity prevalence and substantial reliance on imported food products. This study examines how commercial and health actors framed the proposed introduction of a 75% import tariff on high-sugar products, based on written submissions to the Bermudan government. Methods Eleven submissions containing written comments were analysed with reference to their framing of the proposed import tariff, the ‘problem’ of obesity, and the relationship between the two (including alternative policy approaches for tackling obesity). Results Key emergent frames were complexity, partnership, products, personal responsibility, affordability and evidence. Respondents favoured different framings, depending on whether they supported or opposed the proposed import duty. Commercial actors were universally opposed, presenting obesity as a ‘complex’ problem that would be better addressed through government-industry partnerships (a framing particularly favoured by international and regional business associations). Increased product range and an emphasis on personal responsibility were also positioned as policy alternatives. Health actors expressed partial support for the proposed sugar tax, although this was tempered by a perceived lack of evidence where the proposal differed from sugar taxes introduced elsewhere. Like commercial respondents, health actors framed obesity as a ‘complex’ problem and emphasised the need for other measures, including efforts to address the affordability of fruits and vegetables. Conclusion In responding to a proposed ‘sugar tax’ in Bermuda, commercial actors opposed the proposal and stated a clear preference for ‘partnership’ approaches to tackling obesity. Commercial responses were dominated by local businesses (with only two responses received from international or regional business associations), perhaps reflecting Bermuda’s reliance on tourism and hospitality and the specificity of the proposed intervention (that is, an import tariff rather than an excise tax). The much smaller number of responses from health actors suggests limited civil society capacity. Nevertheless, the Bermudan government successfully introduced a 75% tariff on high-sugar imports, demonstrating the potential for policy innovation to address obesity in small-island jurisdictions. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00877-7.
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Affiliation(s)
- Sarah Williams
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK.,SPECTRUM research consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), University of Edinburgh, EH8 9AG, Edinburgh, UK.,Office for Health Improvement and Disparities, London, UK
| | - Sarah E Hill
- SPECTRUM research consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), University of Edinburgh, EH8 9AG, Edinburgh, UK.,Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK.
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Moe ÅM, Sørbye SH, Hopstock LA, Carlsen MH, Løvsletten O, Ytterstad E. Identifying dietary patterns across age, educational level and physical activity level in a cross-sectional study: the Tromsø Study 2015 - 2016. BMC Nutr 2022; 8:102. [PMID: 36109801 PMCID: PMC9476603 DOI: 10.1186/s40795-022-00599-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background A healthy diet can decrease the risk of several lifestyle diseases. From studying the health effects of single foods, research now focuses on examining complete diets and dietary patterns reflecting the combined intake of different foods. The main goals of the current study were to identify dietary patterns and then investigate how these differ in terms of sex, age, educational level and physical activity level (PAL) in a general Nordic population. Methods We used data from the seventh survey of the population-based Tromsø Study in Norway, conducted in 2015-2016. The study included 21,083 participants aged \documentclass[12pt]{minimal}
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\begin{document}$$72\%$$\end{document}72% completed a comprehensive food frequency questionnaire (FFQ). After exclusion, the study sample included 10,899 participants with valid FFQ data. First, to cluster food variables, the participants were partitioned in homogeneous cohorts according to sex, age, educational level and PAL. Non-overlapping diet groups were then identified using repeated hierarchical cluster analysis on the food variables. Second, average standardized diet intake scores were calculated for all individuals for each diet group. The individual diet (intake) scores were then modelled in terms of age, education and PAL using regression models. Differences in diet scores according to education and PAL were investigated by pairwise hypothesis tests, controlling the nominal significance level using Tukey’s method. Results The cluster analysis revealed three dietary patterns, here named the Meat and Sweets diet, the Traditional diet, and the Plant-based- and Tea diet. Women had a lower intake of the Traditional diet and a higher preference for the Plant-based- and Tea diet compared to men. Preference for the Meat and Sweets diet and Traditional diet showed significant negative and positive trends as function of age, respectively. Adjusting for age, the group having high education and high PAL compared favourably with the group having low education and low PAL, having a significant lower intake of the Meat and Sweets and the Traditional diets and a significant higher intake of the Plant-based- and Tea diet. Conclusions Three dietary patterns (Meat and Sweets, Traditional, and Plant-based- and Tea) were found by repeated clustering of randomly sampled homogeneous cohorts of individuals. Diet preferences depended significantly on sex, age, education and PAL, showing a more unhealthy dietary pattern with lower age, low education and low PAL. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00599-4.
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Mounsey S, Waqa G, McKenzie B, Reeve E, Webster J, Bell C, Thow AM. Strengthening implementation of diet-related non-communicable disease prevention strategies in Fiji: a qualitative policy landscape analysis. Global Health 2022; 18:79. [PMID: 36050736 PMCID: PMC9434519 DOI: 10.1186/s12992-022-00859-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Noncommunicable diseases (NCDs) are the leading cause of death globally, and the World Health Organization (WHO) has recommended a comprehensive policy package for their prevention and control. However, implementing robust, best-practice policies remains a global challenge. In Fiji, despite political commitment to reducing the health and economic costs of NCDs, prevalence of diabetes and cardiovascular disease remain the highest in the region. The objective of this study was to describe the political and policy context for preventing diet-related NCDs in Fiji and policy alignment with WHO recommendations and global targets. We used a case study methodology and conducted (1) semi-structured key informant interviews with stakeholders relevant to diet-related NCD policy in Fiji (n = 18), (2) documentary policy analysis using policy theoretical frameworks (n = 11), (3) documentary stakeholder analysis (n = 7), and (4) corporate political activity analysis of Fiji’s food and beverage industry (n = 12). Data were sourced through publicly available documents on government websites, internet searches and via in-country colleagues and analysed thematically. Results Opportunities to strengthen and scale-up NCD policies in Fiji in line with WHO recommendations included (1) strengthening multisectoral policy engagement, (2) ensuring a nutrition- and health-in-all policy approach, (3) using a whole-of-society approach to tighten political action across sectors, and (4) identifying and countering food industry influence. Conclusion Diet-related NCD policy in Fiji will be strengthened with clearly defined partner roles, responsibilities and accountability mechanisms, clear budget allocation and strong institutional governance structures that can support and counter industry influence. Such initiatives will be needed to reduce the NCD burden in Fiji. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00859-9.
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Affiliation(s)
- Sarah Mounsey
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, City Road, Sydney, NSW, 2006, Australia.
| | - Gade Waqa
- Fiji National University, Suva, Fiji
| | - Briar McKenzie
- The George Institute, City Road, Newtown, NSW, Australia
| | | | - Jacqui Webster
- The George Institute, City Road, Newtown, NSW, Australia
| | - Colin Bell
- School of Medicine and Global Obesity Centre, Geelong Waurn Ponds Campus, Deakin University, Melbourne, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, City Road, Sydney, NSW, 2006, Australia
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Brukało K, Kaczmarek K, Kowalski O, Romaniuk P. Implementation of sugar-sweetened beverages tax and its perception among public health stakeholders. A study from Poland. Front Nutr 2022; 9:957256. [PMID: 35967783 PMCID: PMC9373029 DOI: 10.3389/fnut.2022.957256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background One of tools to tackle growing problem of overweight and obesity are the taxation mechanisms applied to sugar-sweetened beverages, which are expected to influence the common eating behaviors, but also they have impact on the market and public finances. The solution is therefore highly entangled in the complex of social and intersectoral interests generating a number of opportunities and threats affecting its feasibility. Aims The study aims to depict the views of Polish stakeholders on the implementation of the sugar tax in Poland, particularly the perception of success determinants, barriers, as well as views on the features of the implemented solutions and possible alternatives. Methods We used semi-structured interviews with 18 individuals representing key public health stakeholders in Poland. The interview consisted of four parts, where first concentrated on the advantages and disadvantages of the SSB tax, the second part explored stakeholder involvement and stances, third concerned the feasibility of the project, and in the fourth part respondents were asked for suggestions for decision-makers regarding the content of the project and its implementation process. To reconstruct position of 4 main political parties we applied desk research. We used MAXQDA v2020 to analyse the collected data. Results Stakeholders tend to expressed conflicting views on the effectiveness, relevance and socio-economic impact of the SSB tax. All of them agreed that the tax may appear severe for the poorest groups, children and adolescents, while disagreeing about the economic impact of the levy. The allocation of additional tax revenues was raising doubts, with stakeholders believing that the fiscal aim is the basic reason for implementing the tax, while these resources should be primarily dedicated to health promotion intervention and prevention of diet-related diseases. On the other hand, the political debate on the tax was highly superficial with strong populism arising of the presented positions. Conclusions There is a need to conduct a thorough public debate and improvements in terms of public communication to increase social awareness, sealing and refining the implemented solutions. Close cooperation with market players and non-governmental organizations is highly recommended.
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Affiliation(s)
- Katarzyna Brukało
- Department of Health Policy, Chair of Public Health Policy, School of Health Sciences in Bytom, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Kaczmarek
- Department of Health Policy, Chair of Public Health Policy, School of Health Sciences in Bytom, Medical University of Silesia, Katowice, Poland
| | - Oskar Kowalski
- Department of Human Nutrition, Chair of Dietetics, School of Health Sciences in Bytom, Medical University of Silesia, Katowice, Poland
| | - Piotr Romaniuk
- Department of Health Policy, Chair of Public Health Policy, School of Health Sciences in Bytom, Medical University of Silesia, Katowice, Poland
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Martin-Payo R, González-Moradas MDR, Iturrate-Bobes J, Fernández-Sutil A, Cofiño R, Fernandez-Alvarez MDM. Mapping of Outdoor Food and Beverage Advertising around Spanish Schools. Nutrients 2022; 14:nu14153167. [PMID: 35956343 PMCID: PMC9370640 DOI: 10.3390/nu14153167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Overweight and obesity rates have increased worldwide in the last decades. The marketing strategies of food considered to be unhealthy significantly exacerbate the childhood obesity dilemma. Studies typically analyze the content of advertisement in television, movies, or social media, but there is a gap in the assessment of the real-life promotion of food and beverages around the schools. The primary aim of the study was to assess the products advertised around public and concerted schools in three cities in the north of Spain, and to categorize them as healthy (core) or unhealthy (discretionary). The secondary aim was to describe the types of food and beverages in advertisements, as well as to determine the density of core and discretionary product advertisements. A cross-sectional descriptive study was carried out between September and December 2021. The units of analysis were outdoor food and beverage advertisements that were located around public and concerted schools of three cities in the north of Spain. We found 104 schools that met the criteria. We identified 6469 products advertised, 35.1% core and 61.2% discretionary, observing significant differences (p < 0.001) among the cities. Fruit (core) and alcohol (discretionary) were the most heavily advertised products. In conclusion, children attending schools located in the assessed cities are currently exposed to a significant amount of discretionary product advertisement, a situation that should be regulated.
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Affiliation(s)
- Ruben Martin-Payo
- PRECAM Research Group, ISPA Asturias-Spain, Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain;
- Correspondence:
| | | | - Juan Iturrate-Bobes
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain; (J.I.-B.); (A.F.-S.)
| | - Alejandro Fernández-Sutil
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain; (J.I.-B.); (A.F.-S.)
| | - Rafael Cofiño
- Consejería de Salud del Principado de Asturias, 33003 Oviedo, Spain;
| | - María del Mar Fernandez-Alvarez
- PRECAM Research Group, ISPA Asturias-Spain, Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain;
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Grigsby-Duffy L, Cameron AJ, Backholer K, Sacks G. Food industry perspectives on potential policies targeting unhealthy food and beverage price promotions in Australian supermarkets. BMC Public Health 2022; 22:1423. [PMID: 35883174 PMCID: PMC9322738 DOI: 10.1186/s12889-022-13812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Current supermarket price promotions are likely to encourage unhealthy diets, leading some governments to recently endorse restrictions on price promotions for unhealthy food and beverages. However, little is known about the likely industry response to policy action in this area. The aim of this study was to understand how potential government policies targeting food and beverage price promotions in supermarkets are perceived by food industry stakeholders in Australia. Twelve semi-structured in-depth interviews were conducted with current and former employees of major food manufacturers and food retailers as well as other industry experts with experience related to price promotion practices in the Australian supermarket setting. Data were analysed deductively based on Lewin's organisational change theories and inductively to highlight forces that might drive or restrain change.From an industry perspective, forces likely to create industry opposition to implementation of price promotion policy included: fear of losing competitive advantage; potential financial loss for food retailers and their suppliers; a perception that restrictions on price promotions for unhealthy products will not impact health; and a perception of increased financial cost to consumers. Forces perceived to drive implementation of a policy that would benefit public health included: mandatory regulation; extensive compliance monitoring; support for promoting healthy products; consumer education; and sufficient lead time and support from retailers for implementation. These forces, and the way in which they interact, need to be actively considered as part of efforts to change the healthiness of food and beverage price promotions in supermarkets.
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Affiliation(s)
- Lily Grigsby-Duffy
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220 Australia
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220 Australia
| | - Kathryn Backholer
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220 Australia
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220 Australia
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Roche M, Alvarado M, Sandoval RC, Gomes FDS, Paraje G. Comparing taxes as a percentage of sugar-sweetened beverage prices in Latin America and the Caribbean. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:None. [PMID: 35875252 PMCID: PMC9290324 DOI: 10.1016/j.lana.2022.100257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Excise taxes can be used to reduce the consumption of sugar-sweetened beverages (SSBs), an important preventable risk factor for noncommunicable diseases. This study aimed to compare novel standardized indicators of the level of taxes applied on SSBs as a percentage of the price across beverage categories in Latin America and the Caribbean. Methods We used a method developed by the Pan American Health Organization and adapted from the World Health Organization's tobacco tax share. The analysis focused on the most sold brand of five categories of non-alcoholic beverages. Data were collected by surveying ministries of finance and reviewing tax legislation in effect as of March 2019. Findings Of the 27 countries analyzed, 17 applied excise taxes on SSBs. Of these, median excise taxes represented the highest share of the price for large sugar-sweetened carbonated drinks (6·5%) and the lowest for energy drinks (2·3%). In countries where excise taxes were applied on bottled waters, tax incidence exceeded the one applied on most SSBs. Overall, excise tax shares were higher in Latin America than in the Caribbean. Including all other indirect taxes (e.g., value added tax), median total tax shares were between 12·8% and 17·5%. At least two countries earmarked part of SSB excise tax revenues for health purposes. Interpretation Excise tax levels are generally low in the region. From a public health perspective, tax rates could be increased, and tax designs improved (e.g., excluding bottled waters). The method describe here provides a feasible and informative way to monitor SSB taxation and could be replicated in other regions and over time. Funding Bloomberg Philanthropies through the Global Health Advocacy Incubator.
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Key Words
- CIF, Cost, insurance, and freight
- Fiscal policies
- Health economics
- IMF, International Monetary Fund
- LAC, Latin America and the Caribbean
- NCD, Noncommunicable disease
- Noncommunicable diseases
- Nutrition policy
- Obesity
- PAHO, Pan American Health Organization
- PPP, Purchasing power parity
- SSB, Sugar-sweetened beverage
- Sugar-sweetened beverages
- VAT, Value added or sales taxes
- WHO, World Health Organization
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Affiliation(s)
- Maxime Roche
- Centre for Health Economics and Policy Innovation (CHEPI), Imperial College Business School, Exhibition Rd, London SW7 2AZ, UK
| | - Miriam Alvarado
- MRC Epidemiology Unit, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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Hazazi A, Wilson A. Noncommunicable diseases and health system responses in Saudi Arabia: focus on policies and strategies. A qualitative study. Health Res Policy Syst 2022; 20:63. [PMID: 35698126 PMCID: PMC9195368 DOI: 10.1186/s12961-022-00872-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Noncommunicable diseases (NCDs) are responsible for an increasing disease and economic burden in Saudi Arabia, particularly those due to chronic diseases such as diabetes and cardiovascular disease. Efforts are being made to improve chronic disease control through greater prevention and disease management. This research examines the scope, comprehensiveness and perceived effectiveness of Saudi Arabia’s national policies and strategies to prevent and control NCDs and their risk factors. Methods Semi-structured interviews were conducted with 25 managers of the Ministry of Health in Saudi Arabia. The interviewees were public health leaders, national programme directors and programme implementation staff. The interviews were transcribed and coded into key themes. Results Interviewee responses indicated a belief that Ministry of Health programmes for the prevention and control of NCDs have achieved initial success, but have not yet been adequately evaluated. Interviewees reported faster development and implementation of policies for tobacco, sugar-sweetened drinks and obesity than for physical activity. Major challenges identified included inefficient programme management and low community awareness. There was a reported need for greater emphasis on health promotion and improving the effectiveness of existing multisectoral coordination. Conclusion Effective national NCD policies and strategies have a critical role to play in the control of chronic disease epidemics. In Saudi Arabia, opportunities exist to improve the policy and strategies in response to NCDs by establishing a comprehensive surveillance system and linking epidemiological surveillance with health programme evaluation, as well as using a multisectoral and integrated approach. For better management and control of NCDs, a cohesive multisectoral collaboration with a comprehensive surveillance programme and adequate evaluation is urgently needed.
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Affiliation(s)
- Ahmed Hazazi
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, No. 2W21/Level 2, Charles Perkins Centre D17, Sydney, NSW, 2006, Australia. .,Department of Public Health, Faculty of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia.
| | - Andrew Wilson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, No. 2W21/Level 2, Charles Perkins Centre D17, Sydney, NSW, 2006, Australia
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Cawley J, Daly M, Thornton R. The effect of beverage taxes on youth consumption and body mass index: Evidence from Mauritius. HEALTH ECONOMICS 2022; 31:1033-1045. [PMID: 35297120 DOI: 10.1002/hec.4497] [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: 06/22/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Taxes on sugar-sweetened beverages (SSBs) are relatively new and there is limited evidence about their impact on SSB consumption or body mass index (BMI) (as opposed to prices, purchases, or sales), their impact on youth (as opposed to adults), or their impact in non-Western nations. This paper adds to the evidence across all these dimensions by estimating the effect of an SSB tax on SSB consumption and the BMI of youth in Mauritius, an island nation in the Indian Ocean, which we compare to Maldives, another island nation which did not implement an SSB tax during the time of our data. Results of difference-in-differences models indicate that the tax in Mauritius had no detectable impact on the consumption of SSBs or the BMI of the pooled sample of boys and girls. However, models estimated separately by sex indicate that the probability that boys consumed SSBs fell by 9.4 percentage points (11%). These are among the first estimates of the effect of SSB taxes on youth consumption and contribute to the limited evidence on the impact of SSB taxes on weight, and in non-Western countries.
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Affiliation(s)
- John Cawley
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York, USA
| | - Michael Daly
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York, USA
| | - Rebecca Thornton
- Department of Economics, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Strengthening Food Systems Governance to Achieve Multiple Objectives: A Comparative Instrumentation Analysis of Food Systems Policies in Vanuatu and the Solomon Islands. SUSTAINABILITY 2022. [DOI: 10.3390/su14106139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Political leaders from around the world are demonstrating interest in adopting food policies that account for the economic, health, social and environmental dimensions of food. In the Pacific Islands, decades of experience in implementing multisectoral NCD and climate policy has indicated that operationalising food systems policies will be challenging. We aimed to identify opportunities for food systems sectors to more strongly promote nutrition and environmental sustainability in addition to economic objectives. We conducted a comparative documentary analysis of 37 food systems sector policies in Vanuatu and the Solomon Islands. We applied theories of agenda- setting to examine how the frames employed by different sectors, and evident in policy content, shaped policy priorities and activities. We identified a predominately economic framing of issues affecting food systems sectors. Though there were clear policy aims to produce enough food to meet population dietary requirements and to promote an environmentally resilient food supply, aims operationalised more predominately through policy content were those that increase the contribution of productive sectors to food exports and import substitution. Food systems sectors in the Pacific Islands have clear aims to promote nutritious and environmentally resilient food systems, but policy instruments could more strongly reflect these aims.
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Why Don’t You [Government] Help Us Make Healthier Foods More Affordable Instead of Bombarding Us with Labels? Maternal Knowledge, Perceptions, and Practices after Full Implementation of the Chilean Food Labelling Law. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084547. [PMID: 35457415 PMCID: PMC9025178 DOI: 10.3390/ijerph19084547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Experimental and real-life evaluations show that the use of front-of-package warning labels (FoP) in unhealthy foods is well understood and can modify people’s behaviors. However, it is unclear whether these effects remain in the long term because of the risk of message fatigue. The purpose of this study is to explore after four years of implementation of the Chilean Food Labelling law people’s dietary behavior and FoP labels attention. Nine focus groups of mothers (7–10 people each) of children (2–14 yo) were conducted in Santiago, Chile, and macrocodes were developed, combining an iterative process of deductive and inductive thematic analyses. We found that mothers experienced labels’ fatigue but also had greater knowledge about nutrition and appreciation for more natural foods. This greater knowledge about better nutrition interferes with the perception that healthier and less processed foods are financial and physically inaccessible. The key role of schools as an environment for promoting healthier diets in children was strengthened by the mothers. These results suggest that policies based on providing consumer information need reinforcement campaigns to maintain their effectiveness and that we also need to advance policies to improve access and affordability of healthy foods to ensure better diets.
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The effects of a sugar-sweetened beverage tax and a nutrient profiling tax based on Nutri-Score on consumer food purchases in a virtual supermarket: a randomised controlled trial. Public Health Nutr 2022; 25:1105-1117. [PMID: 34728000 PMCID: PMC9991614 DOI: 10.1017/s1368980021004547] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the effects of a sugar-sweetened beverage (SSB) tax and a nutrient profiling tax on consumer food purchases in a virtual supermarket. DESIGN A randomised controlled trial was conducted with a control condition with regular food prices (n 152), an SSB tax condition (n 130) and a nutrient profiling tax condition based on Nutri-Score (n 112). Participants completed a weekly grocery shop for their household. Primary outcome measures were SSB purchases (ordinal variable) and the overall healthiness of the total shopping basket (proportion of total unit food items classified as healthy). The secondary outcome measure was the energy (kcal) content of the total shopping basket. Data were analysed using regression analyses. SETTING Three-dimensional virtual supermarket. PARTICIPANTS Dutch adults aged ≥18 years are being responsible for grocery shopping in their household (n 394). RESULTS The SSB tax (OR = 1·62, (95 % CI 1·03, 2·54)) and the nutrient profiling tax (OR = 1·88, (95 %CI 1·17, 3·02)) increased the likelihood of being in a lower-level category of SSB purchases. The overall healthiness of the total shopping basket was higher (+2·7 percent point, (95 % CI 0·1, 5·3)), and the energy content was lower (-3301 kcal, (95 % CI -6425, -177)) for participants in the nutrient profiling tax condition than for those in the control condition. The SSB tax did not affect the overall healthiness and energy content of the total shopping basket (P > 0·05). CONCLUSIONS A nutrient profiling tax targeting a wide range of foods and beverages with a low nutritional quality seems to have larger beneficial effects on consumer food purchases than taxation of SSB alone.
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Elliott LM, Dalglish SL, Topp SM. Health Taxes on Tobacco, Alcohol, Food and Drinks in Low- and Middle-Income Countries: A Scoping Review of Policy Content, Actors, Process and Context. Int J Health Policy Manag 2022; 11:414-428. [PMID: 32945639 PMCID: PMC9309941 DOI: 10.34172/ijhpm.2020.170] [Citation(s) in RCA: 8] [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: 02/13/2020] [Accepted: 08/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Taxation of tobacco, food, alcohol and other beverages has gained renewed attention in responding to non-communicable diseases (NCDs). While largely built on evidence from high-income countries (HICs), the projected economic and health benefits of these measures have increased calls for their use in price-sensitive low- and middle-income countries (LMICs). However, uptake has been sporadic and there remains little research on why and how LMICs utilise fiscal measures in response to NCDs. METHODS This scoping review analyses factors influencing the design and implementation of health-related fiscal measures in LMICs. Utilising Arksey and O'Malley's scoping review methodology and Walt and Gilson's policy triangle, we considered the contextual, procedural, content and stakeholder-related factors that influenced measures. RESULTS We identified 75 papers focussing on health-related fiscal measures, with 47 (63%) focused on tobacco, 5 on alcohol, 6 on soft drink and 4 studies on food-related fiscal regulation. Thirteen papers analysed multiple measures and most papers (n = 66, 88%) were less than a decade old. Key factors enabling the design and implementation of measures included localised health and economic evidence, policy championing, inter-ministerial support, and global or regional momentum. Impeding factors encompassed negative framing and retaliation by industry, vested interests and governmental policy disjuncture. Aligning with theoretic insights from the policy triangle, findings consistently demonstrated that the interplay between factors - rather than the presence or absence of particular factors - has the most profound impact on policy implementation. CONCLUSION Given the growing urgency to address NCDs in LMICs, this review highlights the need for recognition and rigorous exploration of political economy factors influencing the design and implementation of fiscal measures. Broader LMIC-specific empirical research is needed to overcome an implication noted in much of the literature: that mechanisms used to enact tobacco taxation are universally applicable to measures targeting foods, alcohol and other beverages.
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Affiliation(s)
- Lana M. Elliott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sarah L. Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Institute for Global Health, University College London, London, UK
| | - Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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Forberger S, Reisch L, Meshkovska B, Lobczowska K, Scheller DA, Wendt J, Christianson L, Frense J, Steinacker JM, Luszczynska A, Zeeb H. Sugar-sweetened beverage tax implementation processes: results of a scoping review. Health Res Policy Syst 2022; 20:33. [PMID: 35331245 PMCID: PMC8944035 DOI: 10.1186/s12961-022-00832-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Taxing sugar-sweetened beverages (SSB) is seen as a win–win situation for governments. It is argued that SSB taxes are relatively easy to implement from a practical perspective compared to for example other nutrition policies. However, the implementation of SSB taxation laws does not happen by itself. Therefore, this work examines implementation processes for SSB taxation in terms of (1) pre-implementation context, (2) taxation instruments used and (3) interactions in the implementation process. Ten databases and grey literature were systematically searched for studies reporting on SSB taxation implementation processes up to February 2020. All studies (N = 1248) were screened independently by two reviewers according to predefined criteria. The selection of variables to be extracted was based on the policy cycle heuristic and informed by intervention implementation research. Information on the process of implementing SSB taxation is limited. Only six cases based on three publications were identified, indicating a gap in this research area. SSB taxation implementation was accomplished by hiring a subcontractor for the implementation or using pre-existing tax collection structures. Political and public support within the implementation process seems to be supportive for the city of Berkeley and for Portugal but was not reported for the Pacific Islands. However, the existing data are very limited, and further research on SSB taxation implementation processes is needed to determine whether the aim of the policy and the envisaged outcome are linked in practice.
Registration The protocol was registered with the Open Science Framework (OSF) (osf.io/7w84q/)
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Affiliation(s)
- Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Lucia Reisch
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.,El-Erian Professor of Behavioural Economics and Policy, University of Cambridge, Cambridge, CB3 9ET, United Kingdom
| | - Biljana Meshkovska
- Institute of Basic Medical Sciences, University of Oslo, Domus Medica, Gaustad, Sognsvannsveien 9, 2. etg., 0372, Oslo, Norway
| | - Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, 53238, Wroclaw, Poland
| | - Daniel Alexander Scheller
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Lara Christianson
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Jennifer Frense
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Jürgen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, 53238, Wroclaw, Poland.,National Institute for Human Resilience, University of Colorado at Colorado Springs, 1420 Austin Bluffs Pkwy, CO Springs, CO, 80918, United States of America
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bibliothekstr.1, 28359, Bremen, Germany
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Mulcahy G, Boelsen-Robinson T, Hart AC, Pesantes MA, Sameeha MJ, Phulkerd S, Alsukait RF, Thow AM. A Comparative Policy Analysis of the Adoption and Implementation of Sugar-Sweetened Beverage Taxes (2016-2019) in 16 Countries. Health Policy Plan 2022; 37:543-564. [PMID: 35244693 PMCID: PMC9113088 DOI: 10.1093/heapol/czac004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/23/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Taxes on sugar-sweetened beverages (SSBs) are recommended as part of comprehensive policy action to prevent diet-related non-communicable diseases (NCDs), but have been adopted by only one quarter of World Health Organization (WHO) Member States. This paper presents a comparative policy analysis of recent SSB taxes (2016–19) in 16 countries. This study aimed to analyse the characteristics and patterns of factors influencing adoption and implementation of SSB taxes and policy learning between countries, to draw lessons for future SSB taxes. The data collection and analysis were informed by an analytical framework that drew on ‘diffusion of innovation’ and theories of policy learning. Qualitative data were collected from policy documents and media, in addition to national statistics. Qualitative data were thematically analysed and a narrative synthesis approach was used for integrated case study analysis. We found adaptation and heterogeneity in the approaches used for SSB taxation with a majority of countries adopting excise taxes, and consistent health framing in media and policy documents. Common public frames supporting the taxes included reducing obesity/NCDs and raising revenue (government actors) and subsequent health system savings (non-government actors). Opposing frames focused on regressivity and incoherence with other economic policy (government actors) and posited that taxes have limited health benefits and negative economic impacts on the food industry (industry). Evident ‘diffusion networks’ included the WHO, predominantly in middle-income countries, and some regional economic bodies. We found indications of policy learning in the form of reference to other countries’ taxes, particularly countries with membership in the same economic bodies and with shared borders. The study suggests that adoption of SSB taxation could be enhanced through strategic engagement by health actors with the policy-making process, consideration of the economic context, use of consistent health frames by cross-sector coalitions, and robust evaluation and reporting of SSB taxation.
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Affiliation(s)
- Georgina Mulcahy
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia
| | - Tara Boelsen-Robinson
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia.,Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | | | - Maria Amalia Pesantes
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Peru.,Department of Anthropology and Archaeology, Dickinson College, USA
| | - Mohd Jamil Sameeha
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Thailand
| | - Reem F Alsukait
- Department of Community Health Sciences, King Saud University, Saudi Arabia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia
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Abstract
Increasing rates of non-communicable diseases (NCDs) (obesity, type 2 diabetes, and dental caries) are positively associated with the consumption of added sugars, particularly in sugar-sweetened beverages (SSB). Governments worldwide have implemented SSB taxes to reduce the consumption of sugars added to beverages to reduce the prevalence of NCDs. There is a tax on manufactured products, including SSBs in Brazil. However, in 2016 and 2018, the Brazilian federal government decreased the tax rate, bucking global trends. The SSB industry has criticised such policies, and current tax levels are too low to reduce consumption sufficiently to prevent harm. Research supports positive public health impact potential for a higher SSB tax in Brazil. Sharing experience among countries and complementary policies (nutrition education and front of pack labelling) could increase the positive impacts of an SSB tax. We describe the history of SSB taxes in Brazil and the rationale it provides for specific SSB taxes across the country.
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Arrieta EM, Fischer CG, Aguiar S, Geri M, Fernández RJ, Coquet JB, Scavuzzo CM, Rieznik A, León A, González AD, Jobbágy EG. The health, environmental, and economic dimensions of future dietary transitions in Argentina. SUSTAINABILITY SCIENCE 2022:1-17. [PMID: 35069916 PMCID: PMC8760564 DOI: 10.1007/s11625-021-01087-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/14/2021] [Indexed: 05/04/2023]
Abstract
Diets link human health with environmental sustainability, offering promising pressure points to enhance the sustainability of food systems. We investigated the health, environmental, and economic dimensions of the current diet in Argentina and the possible effects of six dietary change scenarios on nutrient adequacy, dietary quality, food expenditure, and six environmental impact categories (i.e., GHG emissions, total land occupation, cropland use, fossil energy use, freshwater consumption, and the emission of eutrophying pollutants). Current dietary patterns are unhealthy, unsustainable, and relatively expensive, and all things being equal, an increase in income levels would not alter the health dimension, but increase environmental impacts by 33-38%, and costs by 38%. Compared to the prevailing diet, the six healthier diet alternatives could improve health with an expenditure between + 27% (National Dietary Guidelines) to -5% (vegan diet) of the current diet. These dietary changes could result in trade-offs between different environmental impacts. Plant-based diets showed the lowest overall environmental impact, with GHG emissions and land occupation reduced by up to 79% and 88%, respectively, without significant changes in cropland demand. However, fossil energy use and freshwater consumption could increase by up to 101% and 220%, respectively. The emission of eutrophying pollutants could increase by up to 54% for all healthy diet scenarios, except for the vegan one (18% decrease). We conclude that the health and environmental crisis that Argentina (and other developing countries) currently face could be mitigated by adopting healthy diets (particularly plant-based), bringing in the process benefits to both people and nature. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11625-021-01087-7.
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Affiliation(s)
- Ezequiel M. Arrieta
- Instituto Multidisciplinario de Biología Vegetal (IMBIV), CONICET y Universidad Nacional de Córdoba, 5000 Córdoba, Argentina
| | - Carlos González Fischer
- New Zealand Agricultural Greenhouse Gas Research Centre (NZAGRC), Palmerston North, New Zealand
| | - Sebastian Aguiar
- Laboratorio de Análisis Regional y Teledetección (LART), Facultad de Agronomía, Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura (IFEVA), Universidad de Buenos Aires–CONICET, Av. San Martín 4453, C1417DSE Buenos Aires, Argentina
| | - Milva Geri
- Departamento de Economía y Departamento de Matemática de la Universidad Nacional del Sur (UNS), Instituto de Investigaciones Económicas y Sociales del Sur (IIESS)-CONICET, Bahía Blanca, 8000 Buenos Aires, Argentina
| | - Roberto J. Fernández
- Facultad de Agronomía, Cátedra de Ecología e IFEVA-CONICET, Universidad de BuenosAires, 1417 Buenos Aires, Argentina
| | - Julia Becaria Coquet
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, 5000 Córdoba, Argentina
| | - Carlos M. Scavuzzo
- Instituto de Altos Estudios Espaciales “Mario Gulich” CONAE, UNC, 5000 Córdoba, Argentina
| | - Andres Rieznik
- Instituto de Neurociencias Cognitivas y Traslacionales (INCYT) CONICET-Fundación INECO y Universidad Favaloro, Buenos Aires, Argentina
| | - Alberto León
- Instituto de Ciencia y Tecnología de los Alimentos Córdoba, CONICET-Universidad Nacional de Córdoba, Av Filloy s/n, Córdoba, Argentina
| | - Alejandro D. González
- Instituto Andino-Patagónico de Tecnologías Biológicas y Geoambientales (IPATEC), CONICET y Universidad Nacional del Comahue, 8400 Bariloche, Río Negro Argentina
| | - Esteban G. Jobbágy
- Grupo de Estudios Ambientales, CONICET, IMASL, Universidad Nacional de San Luis, Ejército de los Andes 950, 5700 San Luis, Argentina
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Sugary drinks taxation: industry's lobbying strategies, practices and arguments in the Brazilian Legislature. Public Health Nutr 2022; 25:170-179. [PMID: 33820589 PMCID: PMC8825954 DOI: 10.1017/s136898002100149x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the strategies, practices and arguments used by the industry to lobby legislators against sugary drinks taxation in Brazil. DESIGN We performed a content analysis of arguments put forward by sugary drink and sugar industries against sugary drinks taxation, using the framework developed by the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support to assess corporate political activity of the food industry. SETTING Two public hearings held in 2017 and 2018 in the Brazilian Legislature. PARTICIPANTS Representatives from two prominent industry associations - one representing Big Soda and the other representing the main sugar, ethanol and bioelectricity producers. RESULTS The 'Information and messaging' and 'Policy substitution' strategies were identified. Five practices were identified in the 'Information and messaging' strategy (four described in the original framework and an additional practice, 'Stress the environmental importance of the industry'). Mechanisms not included in the original framework identified were 'Stress the reduction of CO2 emissions promoted by the industry'; 'Question the effectiveness of regulation'; 'Suggest public-private partnerships'; 'Shift the blame away from the product' and 'Question sugary drinks taxation as a public health recommendation'. No new practices or mechanisms to the original framework emerged in the 'Policy substitution' strategy. CONCLUSIONS The strategies and practices are used collectively and complement each other. Arguments herein identified are in line with those reported in other countries under different contexts and using different methodologies. Future research should address whether and under what conditions lobbying from this industry sector is effective in the Brazilian Legislature.
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O’Leary C, Cummins S, Smith RD, Cornelsen L. Like parent, like child: a cross-sectional study of intra-household consumption patterns of non-alcoholic beverages among British households with children. Public Health Nutr 2021; 25:1-9. [PMID: 34955119 PMCID: PMC9991679 DOI: 10.1017/s1368980021005061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/03/2021] [Accepted: 12/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Most research investigating sugar-sweetened beverages (SSB) and health, conducted at the individual or household level, ignores potentially important intra-household dynamics. We analysed self-reported consumption relationships between children and adults, and between children of different ages, as well as the associations between intra-household consumption, BMI and sociodemographic characteristics. DESIGN A cross-sectional analysis of survey data from Kantar Fast Moving Consumer Goods panellists in September 2017. SETTING Great Britain. PARTICIPANTS Random sample of 603 households with children under 18 years who regularly purchase non-alcoholic beverages. RESULTS Low- or no-sugar/diet beverages dominate consumption across all age categories, particularly children under 12 years. SSB consumption increased as children became older. Children's reported consumption of SSB and low- or no-sugar/diet beverages was positively associated with consumption by adults; a child in adolescence had over nine times the odds of consuming SSB (adjusted OR 9·55, (95 % CI 5·38, 17·00), P < 0·001), and eight times the odds of consuming low- or no-sugar/diet drinks (adjusted OR 8·12, (95 % CI 4·71, 13·97), P < 0·001), if adults did so. In households with multiple children, consumption patterns of older siblings were associated with those of the younger; notably a perfect correlation between children aged 0 and 6 years consuming SSB if siblings 13-18 years did so, and children aged 7-12 years had 22 times the odds of consuming SSB if siblings aged 13-18 years did so (OR 22·33, (95 % CI 8·60, 58·01), P < 0·001). CONCLUSIONS Multiple policies, targeting children as well as adults, such as fiscal levers and advertisement restrictions, are needed to reduce and prevent the consumption of SSB.
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Affiliation(s)
- Charlotte O’Leary
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street, LondonWC1E 7HT, UK
- Royal Melbourne Hospital, Melbourne, Australia
| | - Steven Cummins
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street, LondonWC1E 7HT, UK
| | - Richard D Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura Cornelsen
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street, LondonWC1E 7HT, UK
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Arrieta EM, Geri M, Coquet JB, Scavuzzo CM, Zapata ME, González AD. Quality and environmental footprints of diets by socio-economic status in Argentina. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 801:149686. [PMID: 34419910 DOI: 10.1016/j.scitotenv.2021.149686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/11/2021] [Indexed: 05/21/2023]
Abstract
Food consumption and production plays a major role on human health and environmental sustainability. In addition, socio-economic status (SES) could be an important determinant on these impacts. Here we investigated the quality and environmental footprints of diets of different SES in Argentina. Dietary data was obtained from a recent national-wide representative survey (21,547 households), and individual intake was estimated by applying the Adult-Male Equivalent (AME) approach. Dietary quality was assessed by comparing the apparent consumption of foods and nutrients with the level of intake associated with the lowest risk of mortality, and applying the Alternate Healthy Eating Index 2010 (AHEI-2010). The environmental footprints were assessed with a set of six environmental indicators: greenhouse gas (GHG) emissions, total land occupation, cropland demand, fossil energy use, freshwater consumption and eutrophying emissions. Per capita total expenditure was utilized as an indicator of SES. We found a suboptimal intake of healthy and excess of unhealthy foods and nutrients in all SES, as well as a low AHEI-2010 score (34.7 ± 3.56 over 100). Regarding environmental footprints per AME, we estimated 8.91 ± 2.49 kg CO2-eq/day for GHG emissions, 9.30 ± 2.93 MJ/day for fossil energy use, 54.2 ± 14.8 m2/day for total land occupation, 7.07 ± 1.90 m2/day for cropland demand, 205 ± 65.3 L/day for freshwater consumption and 19.8 ± 6.43 g PO4-eq/day for eutrophying emissions. The Argentinian diet was found to be both unhealthy and unsustainable in all socio-economic levels.
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Affiliation(s)
- Ezequiel M Arrieta
- Instituto Multidisciplinario de Biología Vegetal (IMBIV), CONICET y Universidad Nacional de Córdoba, 5000 Córdoba, Argentina.
| | - Milva Geri
- Instituto de Investigaciones Económicas y Sociales del Sur (IIESS) CONICET, Departamento de Economía y Departamento de Matemática de la Universidad Nacional del Sur (UNS), Bahía Blanca 8000, Buenos Aires, Argentina
| | - Julia Becaria Coquet
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, 5000 Córdoba, Argentina
| | - Carlos Matias Scavuzzo
- Instituto de Altos Estudios Espaciales "Mario Gulich" CONAE, UNC, 5000 Córdoba, Argentina
| | - María Elisa Zapata
- Center of Studies in Child Nutrition Dr. Alejandro O'Donnell (CESNI), Cerrito 1136, 1 (Post Code 1010), Buenos Aires City, Argentina
| | - Alejandro D González
- Instituto Andino-Patagónico de Tecnologías Biológicas y Geoambientales (IPATEC), CONICET y Universidad Nacional del Comahue, 8400 Bariloche, Río Negro, Argentina
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46
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Duran AC, Mialon M, Crosbie E, Jensen ML, Harris JL, Batis C, Corvalán C, Taillie LS. [Soluciones relacionadas con el entorno alimentario para prevenir la obesidad infantil en América Latina y en la población latina que vive en Estados Unidos]. Obes Rev 2021; 22 Suppl 5:e13344. [PMID: 34708531 DOI: 10.1111/obr.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ana Clara Duran
- Núcleo de Estudos e Pesquisas em Alimentação (NEPA), Universidade Estadual de Campinas, Campinas, Brasil.,Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, Brasil
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublín, Irlanda
| | - Eric Crosbie
- School of Community and Health Sciences, University of Nevada, Reno, Nevada, EE. UU
| | - Melissa Lorena Jensen
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, EE. UU.,Escuela de Nutrición, Universidad de Costa Rica, San José, Costa Rica
| | - Jennifer L Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, EE. UU
| | - Carolina Batis
- CONACYT, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Camila Corvalán
- Instituto de Nutricion y Tecnologia de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, Carolina del Norte, EE. UU
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Menegatti M. Subsidizing risk prevention. JOURNAL OF ECONOMICS 2021; 134:175-193. [DOI: 10.1007/s00712-021-00744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/25/2021] [Indexed: 09/02/2023]
Abstract
AbstractThis work examines the effects of different kinds of subsidies on risk prevention from a theoretical standpoint. We show that both a subsidy on the cost of prevention activities and a subsidy on wealth have ambiguous effects on the level of present contemporaneous prevention. Similar kinds of subsidies have however increasing effects on the level of advance prevention and, under plausible assumptions, on future levels of contemporaneous prevention. We also show that social security subsidies may have decreasing effects on prevention activities while a kind of reverse social security has an increasing effects on them. This indicates that there is a trade-off between the social security aim of mitigating the negative consequences of bad events and the prevention aim of incentivizing choices which reduce the probability that these bad events occur.
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Sandoval RC, Roche M, Belausteguigoitia I, Alvarado M, Galicia L, Gomes FS, Paraje G. [Excise taxes on sugar-sweetened beverages in Latin America and the CaribbeanImposto especial de consumo sobre bebidas açucaradas na América Latina e no Caribe]. Rev Panam Salud Publica 2021; 45:e124. [PMID: 34539768 PMCID: PMC8442714 DOI: 10.26633/rpsp.2021.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/01/2020] [Indexed: 11/26/2022] Open
Abstract
Objetivo. Caracterizar el diseño de los impuestos selectivos al consumo de bebidas azucaradas en América Latina y el Caribe, y evaluar las oportunidades de aumentar su impacto en el consumo y la salud. Métodos. Se llevó a cabo una búsqueda y una evaluación exhaustivas de legislaciones vigentes a marzo del 2019, recopiladas mediante las herramientas de seguimiento ya existentes de la Organización Panamericana de la Salud y de la Organización Mundial de la Salud, fuentes secundarias, así como mediante una encuesta a ministerios de finanzas. El análisis se centró en el tipo de productos gravados y la estructura y la base de estos impuestos selectivos. Resultados. De los 33 países evaluados, en 21 se aplican impuestos selectivos al consumo de bebidas azucaradas. En siete países también se aplican impuestos selectivos sobre el agua embotellada y en al menos cuatro, se aplican tales impuestos sobre las bebidas lácteas azucaradas. Diez de estos impuestos selectivos al consumo son de tipo ad valorem con algunas bases imponibles fijadas en las primeras etapas de la cadena de valor, siete son de tipo específico y cuatro son de estructura combinada o mixta. En tres países se aplican impuestos selectivos al consumo en función de la concentración de azúcares del producto. Conclusiones. Si bien el número de países en que se aplican impuestos selectivos al consumo de bebidas azucaradas es prometedor, existe una gran heterogeneidad en su diseño en cuanto a la estructura, la base imponible y los productos gravados. Se podrían aprovechar aún más los impuestos selectivos existentes para tener un mayor impacto sobre el consumo de bebidas azucaradas y la salud si se incluyeran todas las categorías de bebidas azucaradas, excluyendo el agua embotellada, y si se recurriera más a impuestos específicos ajustados regularmente según la inflación y basados posiblemente en la concentración de azúcares del producto. Todos los países se beneficiarían si hubiera mayor orientación. Futuras investigaciones deberían tener como objetivo abordar esta brecha.
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Affiliation(s)
- Rosa Carolina Sandoval
- Organización Panamericana de la Salud Washington, D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington, D.C. Estados Unidos de América
| | - Maxime Roche
- Organización Panamericana de la Salud Washington, D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington, D.C. Estados Unidos de América
| | | | - Miriam Alvarado
- Universidad de Cambridge Cambridge Reino Unido Universidad de Cambridge, Cambridge, Reino Unido
| | - Luis Galicia
- Ministerio de Salud Pública del Uruguay Montevideo Uruguay Ministerio de Salud Pública del Uruguay, Montevideo, Uruguay
| | - Fabio S Gomes
- Organización Panamericana de la Salud Washington, D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington, D.C. Estados Unidos de América
| | - Guillermo Paraje
- Universidad Adolfo Ibáñez Santiago Chile Universidad Adolfo Ibáñez, Santiago, Chile
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Bombak AE, Colotti TE, Raji D, Riediger ND. Exploring attitudes toward taxation of sugar-sweetened beverages in rural Michigan. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:36. [PMID: 34344480 PMCID: PMC8329609 DOI: 10.1186/s41043-021-00259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND While policies to address "obesity" have existed for decades, they have commonly focused on behavioral interventions. More recently, the taxation of sugar-sweetened beverages is gaining traction globally. This study sought to explore individuals' attitudes and beliefs about sugar-sweetened beverages being taxed in a rural Michigan setting. METHODS This qualitative study was conducted using critical policy analysis. Data were collected in 25 semi-structured, audio-recorded interviews with adult Michiganders. Following data collection, transcripts were coded into themes using NVivo software. RESULTS Four themes emerged in participants' perspectives regarding sugar-sweetened beverages being taxed: resistance, unfamiliarity, tax effects, and need for education. While some participants were unfamiliar with sugar-sweetened beverage taxes, many viewed taxation as a "slippery slope" of government intervention, which invoked feelings of mistrust. In addition, participants predicted a sugar-sweetened beverage tax would be ineffective at reducing intake, particularly among regular consumers, who were frequently perceived as mostly low income and/or of higher weight. CONCLUSIONS Further research is needed to explore perceptions of sugar-sweetened beverage taxes in different geographic areas in the USA to examine how perceptions vary. Policymakers should be aware of the potential implications of this health policy with respect to government trust and stigma towards lower income and higher-weight individuals.
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Affiliation(s)
- Andrea E. Bombak
- Department of Sociology, University of New Brunswick, Tilley Hall, Room 9, Fredericton, NB E3B 5A3 Canada
- School of Health Sciences, Community Health Division, Central Michigan University, 1280 E Campus Dr, Mt Pleasant, MI 48859 USA
| | - Taylor E. Colotti
- School of Health Sciences, Community Health Division, Central Michigan University, 1280 E Campus Dr, Mt Pleasant, MI 48859 USA
| | - Dolapo Raji
- School of Health Sciences, Community Health Division, Central Michigan University, 1280 E Campus Dr, Mt Pleasant, MI 48859 USA
| | - Natalie D. Riediger
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, 407 Human Ecology Building, Winnipeg, MB R3T 2N2 Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
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50
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Eykelenboom M, Djojosoeparto SK, van Stralen MM, Olthof MR, Renders CM, Poelman MP, Kamphuis CBM, Steenhuis IHM. Stakeholder views on taxation of sugar-sweetened beverages and its adoption in the Netherlands. Health Promot Int 2021; 37:6333509. [PMID: 34333638 PMCID: PMC9053456 DOI: 10.1093/heapro/daab114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An increasing number of governments worldwide have introduced a tax on sugar-sweetened beverages (SSB) for public health. However, the adoption of such a policy is still debated in many other countries, such as in the Netherlands. We investigated Dutch stakeholder views on taxation of SSB and perceived barriers and facilitators to its adoption in the Netherlands. Semi-structured interviews were conducted in 2019 with 27 stakeholders from health and consumer organizations, health professional associations, trade associations, academia, advisory bodies, ministries and parliamentary parties. Data were analysed using a thematic content approach. The findings reveal that, between and within sectors, stakeholders expressed contradictory views on the effectiveness, appropriateness and (socio)economic effects of an SSB tax. Perceived barriers to the adoption of an SSB tax in the Netherlands included an unfavourable political context, limited advocacy for an SSB tax, a strong lobby against an SSB tax, perceived public opposition, administrative load and difficulties in defining SSB. Perceived facilitators to its adoption included an increasing prevalence of overweight, disappointing results from voluntary industry actions, a change of government, state budget deficits, a shift in public opinion, international recommendations and a solid legal basis. In conclusion, this study shows that several challenges remain to be overcome for the adoption of an SSB tax in the Netherlands. Similar research on stakeholder views in other countries may further inform SSB tax policy processes.
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Affiliation(s)
- Michelle Eykelenboom
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Princetonlaan 8a, 3584 CB Utrecht, the Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Maartje P Poelman
- Chairgroup Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, 6706 KN Wageningen, the Netherlands
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
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