Implications of Brexit for the effectiveness of the UK soft drinks industry levy on coronary heart disease in England: a modelling study

Abstract

BackgroundAn industry levy on sugar-sweetened beverages (SSB) will be implemented in the UK in 2018. It aims to reduce SSB consumption, a major risk factor for coronary heart disease. Brexit might change the present UK trade system with unknown implications for sugar price. We aimed to estimate the effect of potential changes in the price of sugar due to Brexit, combined with the SSB levy, on coronary heart disease mortality and inequalities in English adults, in the first year after Brexit (2020). MethodsWe modelled a baseline SSB levy scenario, a SSB levy under so-called soft Brexit (in which the UK establishes a free trading agreement with the European Union), and a SSB levy under a so-called hard Brexit (in which the UK takes a World Trade Organization default position). We extended the previously validated International Model for Policy Analysis of Agricultural Commodities and Trade to estimate the effect of each scenario on coronary heart disease deaths prevented or postponed and life-years gained, and we used probabilistic sensitivity analysis to account for uncertainty. The model combined routine data on sugar and SSB trade and price, SSB intake, and coronary heart disease mortality stratified by socioeconomic circumstance. We estimated the change in production costs of SSBs and assumed that the industry would pass the cost increase to the consumer. We assumed an immediate effect of SSB intake on coronary heart disease. FindingsThe SSB levy could result in about 390 deaths prevented or postponed from coronary heart disease (95% uncertainty interval 230–590) and 4710 life-years gained (2790–7070) in 2020. The effect of the levy on coronary heart disease mortality would increase by 4% (about 10 deaths) under soft Brexit and by 8% (about 30 deaths) under hard Brexit, compared with baseline. The levy, even under hard Brexit, will particularly benefit the most deprived socioeconomic quintile, with about 140 deaths prevented or postponed (60–240) in the most deprived group compared with 70 (30–120) in the most affluent group. InterpretationOur study found the SSB levy to be resilient to potential Brexit effects on sugar price. Even when trading under World Trade Organization regulations, the SSB levy would yield benefits for coronary heart disease mortality and inequalities. Brexit negotiations are an important opportunity to introduce further fiscal policies within comprehensive UK strategies to promote healthier diets. FundingPS, AAL, and CM are funded by the National Institute for Health Research (research professorship award to CM).