Beverage Tax Research Articles

11.L. Round table: Fiscal measures for building resilient European health systems

Abstract Currently, over 100 million European citizens are affected by obesity and non-communicable diseases. These health conditions impact individuals and society economically as well as socially. Therefore, an increasing number of Member States has introduced taxes on foods high in fat, sugar, or salt. However, divergent national fiscal health measures can lead to market distortion or fraudulent activities, revealing that, although the responsibility for implementing fiscal measures lies with national governments, health systems of different Member States are much interlinked. The increasing health risks for European citizens and its broader impact underline the importance of resilience in European health systems more than ever before, calling for early response and effective concrete actions from both EU institutions and national governments. Additionally, the topic of resilient health systems currently ranks high on the European agenda, with the Belgian Presidency promoting health system preparedness and early response and health care strengthening as one of their six priorities. The European Commission will also continue its work on this issue for the next five years. The EU has already taken steps in this matter, such as the launch of the European Health Union and the creation of HERA. However, in order to preserve a healthy society, the EU must further develop in this regard. Therefore, this round table discussion will focus on the question of how fiscal measures in Member States can contribute to resilient health systems. It aims to generate ideas on how Ministries of Health can contribute to resilient health systems via fiscal measures compatible with European Community law that promote health and prevent disease. Panellists from the WHO Regional Office for Europe, the Hungarian Ministry of Health and Ecorys, a research-based consultancy, will provide diverse perspectives on the topic. The added value of the round table is laying out possible ways of how both the EU and Member States can contribute to enhancing the resilience of European health systems. In the discussion, knowledge is derived from various research projects, such as Ecorys’ study for DG TAXUD on health taxes, their study for the Dutch Ministry of Finance on sugar taxes, and their literature study on sugar taxation and VAT reduction on fruits and vegetables. Furthermore, as an example of alternative funding mechanisms for resilient health systems, the Hungarian approach to health taxes will be reviewed, since a portion of the tax revenue from their public health tax is used to finance public health initiatives. From a policy perspective, the round table will aid in formulating recommendations for improving the resilience of EU health systems for the next five years. Key messages • Unhealthy foods and drinks consumption poses significant health risks, impacting economy and society, and requiring evidence-based fiscal measures as part of comprehensive measures. • The round table provides public health stakeholders the opportunity to generate recommendations for improving the resilience of EU health systems for the next five years. Speakers/Panelists Kremlin Wickramasinghe Division of Country Health Programs, WHO/Europe, Denmark Krisztina Biró Ministry of Interior, State Secretariat for Health, Budapest, Hungary Soila Karreinen Tampere University, Tampere, Finland Rana Orhan Pees Ecorys, Rotterdam, Netherlands Sara Cerdas Former Member of the European Parliament, Brussels, Belgium

Evaluation of front-of-pack labeling’s impact on unhealthy food consumption in Israeli households

Abstract Background In 2020, Israel introduced front-of-pack labeling (FOPL), marking unhealthy foods high in sugar/salt/saturated fat in red and Mediterranean diet-conforming foods in green, aiming to facilitate healthy choices through clear nutrition information. Methods Two cross-sectional telephone surveys assessed food purchasing, red/green food consumption frequency, label exposure, and perceived impact before labeling (944 households, 2019) and 3 years post-implementation (500 households, 2023). Results Over 90% of respondents in 2023 reported seeing red labels on packages. Nearly 70% checked for red labels when shopping, vs. only 48% who examined the full Nutrition Facts panel on the back of the package. 60% reported preferring unlabeled alternatives within unhealthy categories. Although 50% reported that compared to the period before the labeling, they purchased fewer red-labeled products, a significant decrease in purchasing rates between timepoints was found only for 2 out of 11 unhealthy food categories-sugary drinks (which during 2022 were also taxed by sugar content) and salty snacks. At both timepoints, rates of purchasing and consumption frequency of unhealthy foods were higher among households with children, compared to other households. Multivariate analysis showed that having children under 18, lower education and bigger household size predicted a higher overall unhealthy consumption score. Red label checking was associated with better scores. Conclusions FOPL raised awareness and shows potential for reducing unhealthy consumption, especially when combined with policies like sugar taxation. Their impact on reducing purchases of nutritionally valueless foods (snacks/sugary drinks) is highly valuable. However, red-labeled food consumption remained high among households with children, a strong predictor of higher unhealthy consumption scores. Continued label promotion, child-targeted interventions, and product reformulation incentives are recommended. Key messages • FOPL shows potential of enhancing healthy choices especially when combined with supportive policies. • Results regarding households with children highlight the need for continued promotion, child-targeted interventions, and product reformulation incentives for impacting long-term habits.

Harnessing SSB tax for health and economic prosperity: A Path to sustainable growth

This study explores the implementation of sugar-sweetened beverages (SSB) excise taxes as a policy tool to address public health challenges related to excessive sugar consumption in Indonesia. With rising rates of diabetes and obesity, SSB taxes have been widely adopted globally, yielding positive outcomes such as reduced consumption and increased government revenue. This research synthesizes global evidence through a scoping review and examines how an SSB excise tax could be structured to fit Indonesia’s unique socio-economic context. The findings suggest that a tiered tax based on sugar content would be most effective in curbing consumption while encouraging the beverage industry to innovate healthier alternatives. Revenue generated from the tax, estimated to reach IDR 9.68 trillion annually, could be directed toward public health initiatives, particularly for preventing and managing non-communicable diseases. The study also recommends complementary public health campaigns to raise awareness of the risks associated with sugar consumption. Effective collaboration between the Directorate General of Taxes and the Ministry of Health is crucial for successfully implementing and monitoring the policy. The introduction of SSB excise taxes in Indonesia represents a strategic opportunity to enhance public health, generate substantial government revenue, and support long-term sustainable development.

Report urges Ministers to expand sugar taxes, ban sale of energy drinks to under-16s, and roll out teeth brushing programme in schools.

Report urges Ministers to expand sugar taxes, ban sale of energy drinks to under-16s, and roll out teeth brushing programme in schools.

Cost-effectiveness of tax policies on promoting sustainable diets in Iran: a modeling study

BackgroundImplementation of food taxes may promote sustainable diets in a society. This study estimates the potential short-term impacts of taxes on sugar and sweets (SAS), sugar sweetened beverages (SSB) and hydrogenated oil and animal fats (HOAF) in Iran through a social cost-effectiveness analysis.MethodsIn this study, three tax scenarios were evaluated, including a 25% tax on SASs, a 30% tax on SSBs, and a 30% tax on HOAFs. The data from Iran’s 2019–2020 Household Income and Expenditure Survey (HIES) were utilized, and a simulated population of 1 million individuals aged over 25 years was analyzed. Population impact fraction (PIF) was calculated to estimate the averted number of cases and Disability-Adjusted Life Years (DALYs) under each policy scenario. Additionally, the study assessed water and carbon footprints, as well as all associated costs. Cost-effectiveness was evaluated through incremental cost-effectiveness ratios (ICER) and comparison with WHO-recommended thresholds.ResultsImplementation of taxes on SASs and HOAFs resulted in reductions of 1.09 and 1.08% in water footprint, as well as 0.47 and 1.05% in carbon footprint, respectively. In terms of population health, the interventions resulted in averting 343.92 DALYs (95% UI = 318.62–369.36) for the SSB tax and 1219.01 DALYs (95% UI = 1123.05–1315.77) for the tax on HOAFs. Additionally, the tax on SASs averted 1028.09 DALYs (95% UI = 947.16–1,109). All scenarios were deemed cost-effective based on the WHO threshold for ICER, with values of 0.26 billion Rials/DALY, 0.54 billion Rials/DALY, and 0.17 billion Rials/DALY, respectively.ConclusionThe studied tax scenarios could generate substantial health gains and be cost-effective in Iran. It is recommended that policymakers consider implementing such price policies to promote healthy and sustainable diets.

Modeling and empirical evidence of the impact of implementation of sugar sweetened-beverages tax to reduce non-communicable diseases prevalence: a systematic review.

The surge in non-communicable diseases (NCDs) has been linked to excessive sugar-sweetened beverage (SSB) consumption. In response, the World Health Organization advocates for SSB taxes as a preventive measure. This study conducts a systematic literature review, encompassing simulation modeling and empirical evidence, to evaluate the effectiveness of SSB taxes in diminishing NCD prevalence. A systematic search from August 2002 to August 2022, utilizing databases like ScienceDirect, PubMed, Google Scholar, Wiley Online Library, Springer, and ResearchGate, identified 29 relevant articles worldwide following PRISMA 2020. The Critical Appraisal Skill Programme (CASP) 2018 tool was employed for economic evaluation. Among the selected articles, 22 utilized simulation models in group of countries such as South Africa, the US, the UK, Asia (Philippines, India, Indonesia, Thailand), Australia, and Europe (Germany), while seven were based on US and UK evidence. Simulation modeling consistently demonstrated that SSB taxes significantly reduced NCD incidence, prevalence, and mortality, also bolstering government revenue. Tax rates in simulations ranged from 10 to 25%. However, empirical evidence indicated a limited impact, primarily due to low tax rates. Notably, a UK-specific tax led to a 2.7% reduction in SSB sugar purchases and 40.2% higher purchases of no-levy drinks. The findings suggest that while simulation models demonstrate the potential effectiveness of SSB taxes in reducing NCDs, empirical evidence reveals there is no significant effect of the SSB tax, Based on the study conducted in this study, the SSB tax is not effective in reducing the prevalence of NCDs due to consumer preferences that have not changed. , likely due to the implementation of lower tax rates and failure to fulfill the assumption of subtitution product, physical activity, and so on. The study highlights that SSB tax is not effective in reducing the prevalence of NCDs due to consumer preference that have not change. Multi-actions are needed to support the sustainability of the implementation of the SSB tax, including education and promotion of healthy lifestyles and encouragement to reformulate SSB products by industry.

Modelling impacts of a salt and sugar tax on hypothetical intra-category food substitutions, BMI and environmental footprints in the UK population.

Taxes on unhealthy foods can help improve population health in the United Kingdom (UK), but the health effects of food substitutions resulting from these taxes are often unclear. We investigated the potential impacts of a salt and sugar tax on hypothetical intra-category food substitutions, cost, body-mass index (BMI), and environmental footprints. Purchase panel data from Kantar (2017) were used to determine the most popular foods high in salt or sugar within eight 'salt-intensive'/'sugar-intensive' food categories. Within food categories, the most popular lower salt (≤ 1.5g salt/100g product) and lower sugar (≤ 22.5g sugar/100g product) substitutes were also identified. Hypothetical swaps between high salt/sugar foods and lower salt/sugar substitutes were explored, focusing on changes to cost, caloric intake and BMI, and environmental impacts in the UK population. The suggested intra-category substitutions were largely like-for-like and did not accrue an added overall cost to consumers. The substitutions reduced calorie intake by about 200kcal/day and lowered the prevalence of overweight and obesity in the UK from approximately 60-65% to about 40-45%. The proposed food substitutions led to a total reduction of -2.7Mt of greenhouse gases, ∼ -500.000ha of land, -0.5km3 of blue water, -12km3 of scarcity weighted water, ∼ -12.000t of phosphorus, and nearly - 14.000t of sulphur dioxide over one year for the UK population due to reductions in calorie intake. Food substitutions following a tax on salt and sugar could lead to significant benefits for health and the environment, without necessarily resulting in major changes to people's expenditure on familiar salty and sugary snacks.

Optimal Sin Taxation and Market Power

We study how market power impacts the efficiency and redistributive properties of sin taxation, with an empirical application to sugar-sweetened beverage taxation. We estimate an equilibrium model of the UK drinks market, which we embed in a tax design framework to solve for optimal sugar-sweetened beverage tax policy. Positive price-cost margins for drinks create inefficiencies that lower the optimal rate compared with a perfectly competitive setting. Since profits mainly accrue to the rich, this is partially mitigated under social preferences for equity. Overall, ignoring market power when setting tax policy leads to welfare gains 40 percent below those at the optimum. (JEL D62, H21, H23, H25, L13, L25, L66)

Consumption responses to sweetened beverage taxes by household income in four U.S. cities.

Taxes on sweetened beverages have become an important policy response to growing obesity rates and the prevalence of type 2 diabetes in the U.S. and other nations. Since 2015, eight U.S. cities have implemented these taxes, but so far direct evidence of their impacts on household purchasing behavior is scarce. Of particular interest to many researchers and policy makers is the response of lower-income consumers to these taxes, both because they have higher sweetened beverage consumption on average and because of concerns that sweetened beverage taxes are regressive. This project investigates the income-stratified household response to SSB taxes using a data set containing the purchasing behavior of approximately 400 households in the cities of Seattle, San Francisco, Oakland, and Philadelphia, all of which have recently introduced beverage taxes. Using doubly-robust estimation of dynamic and heterogeneous treatment effects relative to a propensity-matched set of households in three comparison cities, we find that households in taxed cities experience increased prices and reduce their purchases of those beverages, with no evidence of cross-border shopping. We further find differential tax impacts by income level, with lower-income households (households with income <200% of the federal poverty line for their size) reducing their purchases of taxed beverages by nearly 50% - more than double the 18% reduction found in higher-income households (households with income >400% of the federal poverty line for their size). Our finding that lower-income households decrease their consumption more than twice as much as higher-income households suggests that these taxes may reduce health disparities and promote population health.

Association between sugar-sweetened beverage consumption and constructs of the Health Belief Model in young adult students at the University of Chester

BackgroundYoung adults are reported as one of the major consumers of sugar-sweetened beverages (SSBs) globally and the consumption of SSBs is associated with long-term medical conditions. The Health Belief Model (HBM) has been applied to understand SSB consumption by children and adolescents through the use of its constructs. There is a gap in knowlege of HBM application to SSB consumption of young adults. Therefore, the present study was undertaken to fill this gap.ObjectiveThe primary objective of the study was to determine if an association existed between SSB consumption status and the constructs of the HBM: perceived susceptibility, perceived severity, perceived barriers, perceived benefits, self-efficacy, and cues in young adult students.MethodsDesign: Cross-sectional data were obtained using an online self-administered structured questionnaire. Descriptive statistics and Chi-squared (X2) test for association were used to analyse the data.Setting: Participants were recruited via email and WhatsApp.Participants: Seventy young adult students aged 18 to 30 years studying at the University of Chester, England.ResultsThe mean age of the participants was 25.5 years (SD: 3.0). 53% consumed SSBs on a given day. Postgraduates (58%), Blacks (52%), and Asian students (70%) had the greater percentages of SSB consumers. There was a very strong significant association between SSB consumption status and level of perceived severity of diseases from a high intake of SSBs, X2 (1, N = 70) = 6.94, P = 0.01, Cramer’s V = 0.32. Also, a very strong association existed between SSB consumption status and self-efficacy level to control SSB intake, X2 (1, N = 70) = 8.83, P = 0.00, Cramer’s V = 0.36.ConclusionsA high percentage of young adult students especially those from minority ethnic groups in the UK consumed SSBs which indicates that targeted initiatives at these groups are required to control their intake. Interventions to control SSB intake in young adult students should consider increasing their level of perceived severity of diseases from a high intake of SSBs and self-efficacy to control SSB intake. We recommend actions that can further increase their awareness of how serious diseases from a high intake of SSBs are. We also recommend measures intended to increase the confidence of young adultstudents in their ability to avoid SSBs when they are stressed, after writing exam, when they are eating, and when they engage in sedentary activities. In particular, modifying their environment to prevent the availability of SSBs at home and regulating the promotion and cost (via taxation) of SSBs in stores would help to increase their self- efficacy level. Further studies to determine why a greater percentage of postgraduate students are consuming SSBs despite their level of education is required. More comprehensive research on SSB consumption in young adults using the HBM is necessary.

Sugar taxation policy and sugar consumption in Malaysia

Malaysia has been taking initiatives to combat obesity as well as non-communicable diseases. A sugar-sweetened beverage (SSBs) tax was proposed in 2014 and implemented in 2019 with an excise duty of RM0.40 per litre for ready-to-drink sugar content. This article aimed to spark a discussion about Malaysia's current sugar tax policies to reduce excessive sugar consumption among Malaysians. However, the alarming rise in the number of obesity and diet-related noncommunicable diseases indicates that the sugar tax control measures are less effective in combating health issues. This study compares Malaysia's neighbours' sugar tax policies and other sugar consumption-related measures. To combat the emerging sugar-related health issues in Malaysia, the government should collaborate with food manufacturers to reduce the amount of sugar in their food production, abate sugar-containing products’ promotion, educate the consequences of excess sugar consumption at all levels of education, apply sugar taxes with lower tax base rate and specific tax rate depends on sugar addition, and form a regional policy between neighbours.

Alcohol free? An analysis of UK and Scottish Government obesity policies’ engagement with alcohol 1999–2023

Background and aimsAlcoholic beverages can be highly calorific yet remain largely absent from obesity policy debates. This article seeks to identify how Scottish and English obesity policies have engaged with the issue of alcohol consumption since devolution.MethodsObesity policy documents for England and Scotland from 1999 to 2023 were thematically analysed to identify their engagement with alcohol consumption. A stakeholder analysis was undertaken to identify key public health actors and commercial sector policy actors in the debate regarding the inclusion of alcohol in obesity policy. Their engagement with the issue of alcohol as an obesity policy issue was assessed through thematic analysis of consultation responses, along with documents, press releases, reports and other statements on policy (e.g. blog posts) available on stakeholder websites.ResultsWhile alcohol was recognised as a risk factor for obesity within obesity policy documents, no specific measures to address this issue were identified until a consultation on mandatory calorie labelling on alcoholic beverages was proposed in 2020. Engagement with alcohol in the policy documents was mainly limited to voluntary and self-regulatory measures favoured by industry actors who portrayed themselves as a key part of the policy solution. They used the policy focus on childhood obesity as a pretext to exclude alcoholic drink from fiscal and labelling measures. Public health NGOs, by contrast, argued that obesity measures such as mandatory calorie labelling and other obesity policies should be extended to alcoholic beverages.ConclusionThere is an insufficient engagement with alcohol as an obesity policy issue within policy documents and an over-reliance on voluntary and industry-partnership approaches. Alcoholic beverages and reduced alcohol products are excluded from beverage taxes and labelling requirements in ways which are hard to justify. As with other areas of public health policy, this represents an industry-favoured policy agenda, opposed by health NGOs. Further research is needed to understand the influence of these actors on the engagement of obesity policy with alcohol.

Exploring the sugar-sweetened beverage tax (SSBT) pass-through rate in the Irish hospitality sector

BackgroundThe World Health Organization (WHO) supports the use of Sugar-Sweetened Beverage Taxes (SSBTs) as a fiscal lever to help reduce sugar consumption and tackle obesity. Obesity is associated with a range of adverse health outcomes. In response to increasing levels of obesity in Ireland, an SSBT was introduced in 2018. Previous research in Ireland has noted that the pass-through rate of the SSBT in retail (off-site consumption) settings was poor. However, to date, no research has examined the SSBT pass-through rate in hospitality (on-site consumption) venues in Ireland.MethodsThis research examines the SSBT pass-through rate on Coca-Cola versus diet versions of Coca-Cola in a convenience sample of 100 hospitality venues in two provincial Irish cities.ResultsWilcoxon signed rank test analysis revealed that regular Coca-Cola was significantly more expensive compared to the price charged for diet versions of Coca-Cola. However, in 85.6% of cases the same price was charged for both full-sugar and sugar-free drinks. The mean pass-through rate of the SSBT was 33.8%.ConclusionThe effective functioning of the SSBT is premised on persistent price differences between soft drink prices based on sugar content. However, this is barely evident in the hospitality sector in Ireland. A number of recommendations are suggested, including both increasing the SSBT, and increasing it annually in line with inflation.

Sugar-Sweetened Beverages and Diet Related Chronic Non-Communicable Diseases in Sub-Saharan Africa

abstract In Sub-Saharan Africa (SSA), diet-related chronic non-communicable diseases (DR-CNCDs) pose a growing public health threat, jeopardising progress towards achieving Sustainable Development Goal 3.4. One contributing factor to this rising threat is the recent surge in consumption of sugar-sweetened beverages (SSBs), across SSA in recent years. Using the socio-ecological model, this commentary explores the nexus between DR-NCDs and SSBs and offers interventions to address this public health challenge at the individual, interpersonal, community, organisational and policy levels. At the individual level, health education campaigns should target individuals and ensure an increase in awareness creation. The life-course approach underscores the importance of promoting healthier dietary choices from childhood to prevent diet-related non-communicable diseases in later life. Schools and workplaces enforcing local policies that discourage SSB consumption patterns will make a huge difference at the community and organisational levels. At the societal/policy level, comprehensive strategies such as sugar taxes, front-of-pack labelling, advertising restrictions and health education programmes are crucial.

The Limits to Food and Beverage Industry Influence over Fiscal and Regulatory Policy in Latin America.

Little is known about the political, institutional, and social contexts contributing to a decline in food and beverage industry power and influence over fiscal (soda taxes) and regulatory (sales/advertising restrictions and food labels) policy. This article addresses this issue by exploring why Mexico and Chile eventually saw such a decline in the food and beverage industry's influence whereas Brazil was not as successful. I argue that in Mexico and Chile, these outcomes are explained by shifts in presidential, congressional, and bureaucratic interests in pursuing policies that went against industry preferences. This article took a qualitative methodological approach to comparative historical research. Policymakers' interest in pursuing stronger food and beverage regulations were shaped by economic and public health concerns, new electoral contexts, epidemiological information, and normative beliefs. In Mexico, the infiltration of nutrition researchers within government facilitated this process. In contrast, Brazil's government was divided about pursuing regulatory policies, with presidents favoring partnerships with industry to implement a popular anti-hunger program; industry's power endured there with limited progress in policy reforms. Governments can eventually overcome industry power and policy influence, but it depends on a whole government commitment to reform.

The Risk Of Perpetuating Health Disparities Through Cost-Effectiveness Analyses.

Cost-effectiveness analyses are commonly used to inform health care and public health policy decisions. However, standard approaches may systematically disadvantage marginalized groups by incorporating assumptions of persisting health inequities. We examined how competing risks, baseline health care costs, and indirect costs can differentially affect cost-effectiveness analyses for racial and ethnic minority populations. We illustrate that these structural factors can reduce estimated quality-adjusted life-years and cost savings for disadvantaged groups, making interventions focused on disadvantaged populations appear less cost-effective. For example, analyses of a sugar-sweetened beverage tax may estimate higher costs per quality-adjusted life-year gained for Black versus White populations because of differences in competing risks and insurance status that manifest in higher health care cost savings from averted disease among White people. To ensure that cost-effectiveness assessments do not perpetuate inequities, alternative approaches are needed that account for the impact of structural factors on different groups and that consider scenarios in which health inequities are reduced. Sensitivity analyses focusing on health equity could help advance interventions that disproportionately benefit disadvantaged communities.

City-Level Sugar-Sweetened Beverage Taxes and Youth Body Mass Index Percentile

Levying excise taxes on sugar-sweetened beverage (SSB) distributors, which are subsequently passed on to consumers, is a policy implemented to reduce the high prevalence of cardiometabolic disease and generate public health funding. Taxes are associated with lower SSB purchases and consumption, but it is unknown whether they are associated with weight-related outcomes in youth. To determine the association of SSB excise taxes with youth body mass index (BMI) trajectories. This cohort study was conducted from 2009 to 2020, including 6 years before tax implementation and 4 to 6 years after tax implementation. The California cities of Albany, Berkeley, Oakland, and San Francisco, which implemented SSB excise taxes, were compared against 40 demographically matched control cities in California. Participants included Kaiser Permanente members aged 2 to 19 years at cohort entry (baseline) with continuous residence in selected cities with at least 1 pretax and 1 posttax BMI recorded in their electronic health record. Data analysis was performed from January 2021 to May 2023. Implementation of SSB excise taxes. Centers for Disease Control and Prevention age-specific and sex-specific BMI percentiles and percentage of youth with overweight or obesity before tax implementation through 4 to 6 years after implementation were compared with control cities. Statistical analysis was conducted using the difference-in-differences (DID) method. A sensitivity analysis used the synthetic control method. A total of 44 771 youth (mean [SD] age at baseline, 6.4 [4.2] years; 22 337 female [49.9%]) resided in the cities with SSB taxes; 345 428 youth (mean [SD] age, 6.9 [4.2] years; 171 0168 female [49.5%]) resided in control cities. There was a -1.64-percentage point (95% CI, -3.10 to -0.17 percentage points) overall difference in the mean change of BMI percentile between exposure and control cities after SSB tax implementation. There was no significant overall difference in the percentage of youth with overweight or obesity or youth with obesity compared with control cities. All DID estimates were significant for youth residing in exposure cities in terms of BMI percentile (age 2-5 years in 2017, -2.06 percentage points [95% CI, -4.04 to -0.09 percentage points]; age 6-11 years in 2017, -2.79 percentage points [95% CI, -4.29 to -1.30 percentage points]), percentages of youth with overweight or obesity (age 2-5 years, -5.46 percentage points [95% CI, -8.47 to -2.44 percentage points]; age 6-11 years, -4.23 percentage points [95% CI, -6.90 to -1.57 percentage points]), and percentages of youth with obesity (age 2-5 years; -1.87 percentage points [95% CI, -3.36 to -0.38 percentage points]; age 6-11 years, -1.85 percentage points [95% CI, -3.46 to -0.24 percentage points]). Compared with control cities, changes in mean BMI percentiles were significant for male (-1.98 percentage points; 95% CI, -3.48 to -0.48 percentage points), Asian (-1.63 percentage points; 95% CI, -3.10 to -0.16 percentage points), and White (-2.58 percentage points; 95% CI, -4.11 to -1.10 percentage points) youth. Compared with control cities, White youth in exposure cities had improvements in the percentage with overweight or obesity (-3.73 percentage points; 95% CI, -6.11 to -1.35 percentage points) and the percentage with obesity (-2.78 percentage points; 95% CI, -4.18 to -1.37 percentage points). In this cohort study, SSB excise taxes were associated with lower BMI percentile among youth. Policymakers should consider implementing SSB excise taxes to prevent or reduce youth overweight and obesity and, ultimately, chronic disease, particularly among children younger than 12 years.

The implications of policy modeling assumptions for the projected impact of sugar-sweetened beverage taxation on body weight and type 2 diabetes in Germany

BackgroundEvaluating sugar-sweetened beverage (SSB) taxation often relies on simulation models. We assess how assumptions about the response to SSB taxation affect the projected body weight change and subsequent health and economic impacts related to type 2 diabetes mellitus (T2DM) using Germany as an example.MethodsIn the main analysis, we estimated changes in energy intake by age and sex under a 20% value-added tax on SSBs in Germany using marginal price elasticities (PE) and applied an energy equilibrium model to predict body weight changes. We then quantified the impact of several assumption modifications: SSB own-PE adjusted for consumption (M1)/based on alternative meta-analysis (M2); SSB consumption adjusted for underreporting (M3); substitution via marginal (M4a) or adjusted (M4b) cross-PE/as % of calorie change (M4c). We also assessed scenarios with alternative tax rates of 10% (S1) or 30% (S2) and including fruit juice (S3). We calculated overweight and obesity rates per modification and scenario. We simulated the impact on T2DM, associated healthcare costs, and disability-adjusted life years (DALYs) over the lifetime of the 2011 German adult population with a Markov model. Data included official demographics, national surveys, and meta-analyses.ResultsA 20% value-added tax in Germany could reduce the number of men and women with obesity by 210,800 [138,800; 294,100] and 80,800 [45,100; 123,300], respectively. Over the population’s lifetime, this would lead to modest T2DM-related health and economic impacts (76,700 DALYs [42,500; 120,600] averted; €2.37 billion [1.33; 3.71] costs saved). Policy impacts varied highly across modifications (all in DALYs averted): (M1) 94,800 [51,500; 150,700]; (M2) 164,200 [99,500; 243,500]; (M3) 52,600 [22,500; 91,100]; (M4a) -18,100 [-111,500; 68,300]; (M4b) 25,800 [-31,400; 81,500]; (M4c) 46,700 [25,300; 77,200]. The variability in policy impact related to modifications was similar to the variability between alternative policy scenarios (all in DALYs averted): (S1) 26,400 [9,300; 47,600]; (S2) 126,200 [73,600; 194,500]; (S3) 342,200 [234,200; 430,400].ConclusionsPredicted body weight reductions under SSB taxation are sensitive to assumptions by researchers often needed due to data limitations. Because this variability propagates to estimates of health and economic impacts, the resulting structural uncertainty should be considered when using results in decision-making.

Does a Soda Tax Make Sense? A Dual-City Survey Study in Philadelphia and Oakland

Does a Soda Tax Make Sense? A Dual-City Survey Study in Philadelphia and Oakland

Estimated reduction in obesity prevalence and costs of a 20% and 30% ad valorem excise tax to sugar-sweetened beverages in Brazil: A modeling study.

The consumption of sugar-sweetened beverages (SSBs) is associated with obesity, metabolic diseases, and incremental healthcare costs. Given their health consequences, the World Health Organization (WHO) recommended that countries implement taxes on SSB. Over the last 10 years, obesity prevalence has almost doubled in Brazil, yet, in 2016, the Brazilian government cut the existing federal SSB taxes to their current 4%. Since 2022, a bill to impose a 20% tax on SSB has been under discussion in the Brazilian Senate. To simulate the potential impact of increasing taxes on SSB in Brazil, we aimed to estimate the price-elasticity of SSB and the potential impact of a new 20% or 30% excise SSB tax on consumption, obesity prevalence, and cost savings. Using household purchases data from the Brazilian Household Budget Survey (POF) from 2017/2018, we estimated constant elasticity regressions. We used a log-log specification by income level for all beverage categories: (1) sugar-sweetened beverages; (2) alcoholic beverages; (3) unsweetened beverages; and (4) low-calorie or artificially sweetened beverages. We estimated the adult nationwide baseline intake for each beverage category using 24-h dietary recall data collected in 2017/2018. Taking group one as the taxed beverages, we applied the price and cross-price elasticities to the baseline intake data, we obtained changes in caloric intake. The caloric reduction was introduced into an individual dynamic model to estimate changes in weight and obesity prevalence. No benefits on cost savings were modeled during the first 3 years of intervention to account for the time lag in obesity cases to reduce costs. We multiplied the reduction in obesity cases during 7 years by the obesity costs per capita to predict the costs savings attributable to the sweetened beverage tax. SSB price elasticities were higher among the lowest tertile of income (-1.24) than in the highest income tertile (-1.13), and cross-price elasticities suggest SSB were weakly substituted by milk, water, and 100% fruit juices. We estimated a caloric change of -17.3 kcal/day/person under a 20% excise tax and -25.9 kcal/day/person under a 30% tax. Ten years after implementation, a 20% tax is expected to reduce obesity prevalence by 6.7%; 9.1% for a 30% tax. These reductions translate into a -2.8 million and -3.8 million obesity cases for a 20% and 30% tax, respectively, and a reduction of $US 13.3 billion and $US 17.9 billion in obesity costs over 10 years for a 20% and 30% tax, respectively. Study limitations include using a quantile distribution method to adjust self-reported baseline weight and height, which could be insufficient to correct for reporting bias; also, weight, height, and physical activity were assumed to be steady over time. Adding a 20% to 30% excise tax on top of Brazil's current federal tax could help to reduce the consumption of ultra-processed beverages, empty calories, and body weight while avoiding large health-related costs. Given the recent cuts to SSB taxes in Brazil, a program to revise and implement excise taxes could prove beneficial for the Brazilian population.