Abstract
BackgroundTaxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax.MethodsFour electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions.ResultsThirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38–0.47) supports an SSBs tax, 39% (0.29–0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60–0.72) supports an SSBs tax if revenue is used for health initiatives.ConclusionsBeliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation.
Highlights
Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity
An additional two articles were identified in citation searches, resulting in a total of thirty-seven articles being included in this review reporting on sixteen qualitative studies, twenty-three quantitative studies and one mixed-method study (Fig. 1)
The majority of studies (n = 32) investigated public acceptability of an SSBs tax, three studies investigated political acceptability of an SSBs tax, and the remaining five studies investigated both political and public acceptability of an SSBs tax
Summary
Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Consumption of sugar-sweetened beverages (SSBs) has been identified as an important modifiable risk factor for overweight and obesity [1]. Results from large prospective cohort studies and randomized controlled trials (RCTs) indicate that SSB consumption promotes weight gain in both children and adults [3]. RCTs in children showed a 0.12 to 0.17-unit reduction in body mass index gain when SSBs were reduced, whereas RCTs in adults showed a 0.85 to 1.20 kg increase in body weight when SSBs were added [3]. SSB consumption is associated with an increased risk of type 2 diabetes, cardiovascular disease and dental caries [1]
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