International trade, dietary change, and cardiovascular disease health outcomes: Import tariff reform using an integrated macroeconomic, environmental and health modelling framework for Thailand.

Henning Tarp Jensen,Rosemary Green,Soledad Cuevas,Alan D Dangour,Wichai Aekplakorn,Edward Joy,Bhavani Shankar,Sanjay Basu,Nalitra Thaiprasert,Richard D Smith,Nipa Rojroongwasinkul,Marcus R Keogh-Brown,Shabbir H Gheewala

doi:10.1016/j.ssmph.2019.100435

Abstract

United Nations (UN) member states have, since 2011, worked to address the emerging global NCD crisis, but progress has, so far, been insufficient. Food trade policy is recognised to have the potential to impact certain major diet-related health and environmental outcomes. We study the potential for using import tariff protection as a health and environmental policy instrument. Specifically, we apply a rigorous and consistent Macroeconomic-Environmental-Demographic-health (MED-health) simulation model framework to study fiscal food policy import tariffs and dietary change in Thailand over the future 20 year period 2016-2035. We find that the existing Thai tariff structure, by lowering imports, lowers agricultural Land Use Change (LUC)-related GHG emissions and protects against cholesterol-related cardiovascular disease (CVD). This confirms previous evidence that food trade, measured by import shares of food expenditures and caloric intakes, is correlated with unhealthy eating and adverse health outcomes among importing country populations. A continued drive towards tariff liberalization and economic efficiency in Thailand may therefore come at the expense of reduced health and environmental sustainability of food consumption and production systems. Due to large efficiency losses, the existing tariff structure is, however, not cost-effective as an environmental or health policy instrument. However, additional simulations confirm that stylized 30% food sector import tariffs generally improve nutritional, clinical health, demographic, and environmental indicators across the board. We also find that diet-related health improvements can go hand-in-hand with increased Saturated Fatty Acid (SFA) intakes. Despite limited cost-effectiveness, policy makers from Thailand and abroad, including WHO, would therefore be well advised to consider targeted fiscal food policy tariffs as a potential intervention to maintain combined health and environmental sustainability, and to reconsider the specification of WHO dietary guidelines with their focus on SFA intake (rather than composition of fatty acid intake) targets.

Highlights

The political need to address growing diet-related health problems at the global level has recently received widespread recognition
Our study aims to fill this void by applying a fully integrated quantitative MED-health simulation model with an explicit and clearly defined cholesterol-related cardiovascular disease (CVD)-focused health pathway where nutritional exposure is governed by household-specific Almost Ideal Demand Systems (AIDS), where our Total:HDL ratio cholesterol biomarker is governed by a validated structural relationship with fatty acid intake shares (Mensink et al 2003), and where clinical health outcomes, as well as pecuniary health cost and labour market feedback effects, are derived from rigorous modelling (Jensen et al 2019)
While simple tariff elimination may reduce cumulative real GDP, the results show that potentially large economic efficiency gains can be reaped by eliminating food import tariffs in Thailand

Summary

Introduction

In September 2011, United Nations (UN) member states, gathering at the first UN High-Level Meeting on non-communicable diseases (NCDs), accepted, for the first time, that a global NCD crisis was emerging (UN 2011). The 66th World Health Assembly subsequently endorsed the WHO Global Action Plan for the Prevention and Control of Non-communicable Disease 2013-2020 (WHO 2013). The WHO Global Action Plan established six objectives and identified a list of 16 costeffective interventions, the so-called ‘best buys’ (WHO 2013). While the new list of (cost-effective) interventions to reduce modifiable risk factors for NCDs (Objective 3) included excise taxes to reduce tobacco use and harmful use of alcohol, no tax interventions were proposed for improving unhealthy diets

Methods

Results

Conclusion