Abstract
Food pricing strategies have been proposed to encourage healthy eating habits, which may in turn help stem global increases in non-communicable diseases. This systematic review of simulation studies investigates the estimated association between food pricing strategies and changes in food purchases or intakes (consumption) (objective 1); Health and disease outcomes (objective 2), and whether there are any differences in these outcomes by socio-economic group (objective 3). Electronic databases, Internet search engines, and bibliographies of included studies were searched for articles published in English between 1 January 1990 and 24 October 2011 for countries in the Organisation for Economic Co-operation and Development. Where ≥ 3 studies examined the same pricing strategy and consumption (purchases or intake) or health outcome, results were pooled, and a mean own-price elasticity (own-PE) estimated (the own-PE represents the change in demand with a 1% change in price of that good). Objective 1: pooled estimates were possible for the following: (1) taxes on carbonated soft drinks: own-PE (n = 4 studies), -0.93 (range, -0.06, -2.43), and a modelled -0.02% (-0.01%, -0.04%) reduction in energy (calorie) intake for each 1% price increase (n = 3 studies); (2) taxes on saturated fat: -0.02% (-0.01%, -0.04%) reduction in energy intake from saturated fat per 1% price increase (n = 5 studies); and (3) subsidies on fruits and vegetables: own-PE (n = 3 studies), -0.35 (-0.21, -0.77). Objectives 2 and 3: variability of food pricing strategies and outcomes prevented pooled analyses, although higher quality studies suggested unintended compensatory purchasing that could result in overall effects being counter to health. Eleven of 14 studies evaluating lower socio-economic groups estimated that food pricing strategies would be associated with pro-health outcomes. Food pricing strategies also have the potential to reduce disparities. Based on modelling studies, taxes on carbonated drinks and saturated fat and subsidies on fruits and vegetables would be associated with beneficial dietary change, with the potential for improved health. Additional research into possible compensatory purchasing and population health outcomes is needed.
Highlights
Non-communicable diseases (NCDs) including heart disease, stroke, diabetes, cancers, and chronic respiratory disease are the leading preventable causes of global morbidity and mortality [1]
Meta-analysis techniques were not used in combining the findings of simulation studies, as such models use a variety of structures and mathematical techniques to estimate the impact of an intervention, in contrast to, for example, randomised controlled trial (RCT), which are amenable to metaanalysis because they follow one relatively standard technique or method
This review focused on the potential of food pricing strategies to improve the quality of population diets and associated health and NCD outcomes
Summary
Non-communicable diseases (NCDs) including heart disease, stroke, diabetes, cancers, and chronic respiratory disease are the leading preventable causes of global morbidity and mortality [1]. These diseases place substantial burden on national economies, contribute to poverty, and are a major cause of health inequalities [2,3,4]. Nutrition-related risk factors such as low fruit and vegetable intake and high saturated fat and sodium intakes are causative risk factors for NCDs. Improving population diets and reducing sodium intake were recently identified as two priority areas for action at the United Nations High Level Meeting on Prevention and Control of NCDs in September 2011 [5]. The main behavioral risk factors for all these diseases are tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diets (diets that have a low fruit and vegetable intake and high saturated fat and salt intakes)
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