Beverage Tax Research Articles

Israel’s repeal of sugar-sweetened beverages tax harms public health

Abstract Issue The consumption of sugar-sweetened beverages (SSBs) exerts negative consequences on both individual and public health. High sugar consumption is associated with the development of non-communicable diseases, increases health care costs, and reduces labor productivity. The WHO and the World Bank thus encourage countries to tax SSBs. Description In January 2023, the Israeli government decided to repeal the SSB tax which had been imposed a year earlier. Our study seeks to attain an in-depth understanding of the reasons for the tax repeal by analyzing such documents as parliamentary protocols and media articles. Results Israel's SSB tax was criticized severely by the ultra-orthodox community, which maintains a tradition of consuming sweets as part of its customs and culture. In the absence of a plan to change the community's habits, the tax was perceived as a politically motivated economic burden. Moreover, this perception was intensified by the ultra-orthodox political leaders, who portrayed the tax as unfairly targeting the ultra-orthodox community. Lessons When considering the implementation of a tax on SSBs, policymakers must ensure that this tax is not perceived as an economic sanction or as a means of targeting a specific community. To this end, it is critical to illustrate that the tax seeks solely to promote public health. The public should thus be informed about the harmful effects of SSBs and about the importance of reducing their consumption. Furthermore, this information should be adapted to different sectors and conveyed through various means. In this respect, it is particularly important to understand the attitudes and potential conflicts of closed communities and to obtain the support of community leaders. Key messages • To successfully implement an SSB tax, health authorities must clarify that the tax is a public health tool, not an economic or political sanction. • Policy makers should endeavor to convince all communities to support and accept the transition to healthier beverages before taxing SSBs.

A systematic scoping review evaluating sugar-sweetened beverage taxation from a systems perspective

Systems thinking can reveal surprising, counterintuitive or unintended reactions to population health interventions (PHIs), yet this lens has rarely been applied to sugar-sweetened beverage (SSB) taxation. Using a systematic scoping review approach, we identified 329 papers concerning SSB taxation, of which 45 considered influences and impacts of SSB taxation jointly, involving methodological approaches that may prove promising for operationalizing a systems informed approach to PHI evaluation. Influences and impacts concerning SSB taxation may be cyclically linked, and studies that consider both enable us to identify implications beyond a predicted linear effect. Only three studies explicitly used systems thinking informed methods. Finally, we developed an illustrative, feedback-oriented conceptual framework, emphasizing the processes that could result in an SSB tax being increased, maintained, eroded or repealed over time. Such a framework could be used to synthesize evidence from non-systems informed evaluations, leading to novel research questions and further policy development.

Expanded policy rationales support sugar-sweetened beverage taxes.

Expanded policy rationales support sugar-sweetened beverage taxes.

A New Wave of Sugar-Sweetened Beverage Taxes: Are They Meeting Policy Goals and Can We Do Better?

Little progress has been made in reducing deaths from chronic noncommunicable diseases associated with being overweight or obese worldwide, prompting the World Health Organization and others to recommend the implementation of taxes on sugar-sweetened beverages (SSBs). In response, SSB taxes have been widely implemented over the last decade, and a burgeoning literature aims at understanding their effects. We assess the state of knowledge regarding the impacts of SSB taxes and provide context for the results reported to date based on the recent consumer behavior literature and incentives of supply-chain intermediaries in modern food markets. Evidence suggests only a portion of a tax on distributors or manufacturers is passed forward to consumers, inducing only mild and highly variable impacts on SSB purchases. We argue that the literature provides no consistent evidence that SSB taxes have incentivized increased purchases of healthier beverages and caused overall SSB consumption to decrease. Finally, we consider the efficacy of SSB taxes, alone or in combination with other policies, as part of jurisdictions’ policy goals, including promoting healthier diets, generating revenue, and improving equity.

Cost-benefit analysis of alternative tax policies on sugar-sweetened beverages in Mexico.

In 2014, Mexico implemented a tax on sugar-sweetened beverages (SSB) equivalent to one Mexican peso (MP) per liter to address the high obesity prevalence. This tax has effectively reduced SSB purchases and yielded healthcare savings; however, it remains unknown whether SSB taxes lead to net benefits at the societal level in Mexico. Moreover, public health experts recommend increasing the tax. The objective of this study is to estimate the net benefits of SSB taxes compared to a scenario of no tax in urban Mexico. Taxes include the one-MP tax and alternative higher taxes (two and three MP per SSB liter). Thus, we conducted a cost-benefit analysis from the perspective of the government, producers, and consumers for a simulated closed cohort of adults in a life-table model. We defined net benefits as the difference between economic benefits (the value of statistical life, healthcare savings, and tax revenue) and costs (consumer surplus and profit losses). We found that, at the societal level, all simulated taxes will eventually generate benefits that surpass costs within ten years. Overall net benefits can reach USD 7.1 billion and 15.3 billion for the one-MP and the three-MP tax, respectively. Hence, these benefits increased at a declining rate compared to taxes. The government and consumers will experience overall positive net benefits among society's members. Policymakers should consider time horizons and tradeoffs between health gains and economic outcomes across different society members.

Policy networks and competing interests in the development of the Mexican sugar-sweetened beverages tax

IntroductionSugar taxes threaten the business models and profits of the food and beverage industry (F&BI), which has sought to avert, delay or influence the content of health taxes globally. Mexico...

A sweet deal for domestic industry: the political economy and framing of Vanuatu’s sugar-sweetened beverage tax

IntroductionThe Government of Vanuatu introduced an excise tax on sugar-sweetened beverages (SSBs) in 2015. While lauded for its alignment with the WHO’s Best Buys recommendations for addressing non-communicable diseases (NCDs),...

Health taxes in Indonesia: a review of policy debates on the tobacco, alcoholic beverages and sugar-sweetened beverage taxes in the media

IntroductionOne of the WHO’s ‘best buys’ in controlling non-communicable diseases and their risk factors is to impose health taxes. While the Indonesian political process inhibits the implementation of health tax...

Taxation of tobacco, alcohol, and sugar-sweetened beverages: reviewing the evidence and dispelling the myths

The article reviews the large body of evidence on how taxation affects the consumption of tobacco, alcohol, and sugar-sweetened beverages (SSB). There is abundant evidence that demand for tobacco, alcohol,...

Consumer demand analysis of sugar-sweetened beverages in Nigeria

Sugar-sweetened beverages (SSB) represent a leading public health concern worldwide and the World Health Organization recommends for fiscal approach, by raising prices through taxation to discourage the consumption of SSB. This study was conducted to explain the consumer demand for sugar-sweetened beverages in Nigeria. The key objective of the study is to estimate expenditure and price elasticity of demand as a first and necessary step to assess the impact of the sugar tax. Data from the 2018-2019 National Living Standard Survey (NLSS), which contains detailed information on household food and beverage consumption as well as socio-economic variables was used. The Quadratic Almost Ideal Demand System was employed for estimation. The expenditure elasticity results revealed all non-alcoholic beverages to be normal goods, sachet water is categorised as a necessity, while bottled water and all sugary drinks were revealed to be luxury beverages. Own-price elasticity for all beverages was revealed to be greater than a unit (in absolute terms), implying that the beverages are price elastic. For SSB, malt drinks and soft drinks had higher elasticity estimates of -3.21 and -2.10 respectively. Also, substitutability was observed between SSBs and sachet water. These results show that demand for SSB is price-sensitive and the effective implementation SSB- tax has the potential to discouraging consumption of SSB in Nigeria.

Advertising and Stocking at Small Retailers: A Sweetened Beverage Excise Tax in Philadelphia

In 2017, Philadelphia enacted a $0.015 per ounce excise tax on SBs that covered both sugar-sweetened beverages and artificially-sweetened beverages, which reduced purchasing and consumption. This study assessed whether the tax also changed beverage advertising or stocking practices that could influence consumer behavior among stores in Philadelphia, Baltimore, and Philadelphia-adjacent counties not subject to the tax. Using a longitudinal difference-in-differences approach, beverage advertising and availability changes were evaluated from 4-month pretax to 6-, 12-, and 24-month post-implementation in small independent stores in Philadelphia (n=34) and Philadelphia-adjacent counties (n=38) versus Baltimore (n=43), a demographically similar city without a tax. Mixed effects models tested whether beverage advertising/availability increased in Philadelphia and surrounding counties after implementation versus Baltimore, included store-level random intercepts, and were stratified by beverage tax status, type, size, and store ZIP code income. Data were collected from 2016 to 2018, and analyses were performed in 2022-2023. SB advertising increased post-tax in Philadelphia (6 months= +1.04 advertisements/store [95% CI=0.27, 1.80]; 12 months= +1.54 [95% CI=0.57, 2.52]; 24 months= +0.91 [95% CI=0.09, 1.72]) relative to Baltimore. This was driven by increased advertising of sweetened beverages in low-income ZIP codes. Marketing of SBs increased significantly in Philadelphia-adjacent counties relative to Baltimore. Although SB availability in Philadelphia did not change, it increased in surrounding county stores (6 months= +0.20 [95% CI=0.15, 0.25]; 12 months= +0.08 [95% CI=0.03, 0.12]) relative to Baltimore. Marketing of SBs, especially in low-income neighborhoods and in surrounding counties, increased following Philadelphia's beverage tax among small, independent retailers. These increases in advertising might have dampened the tax's effect on purchasing behaviors, although estimated effects on sales remained large.

Does sugar taxation on sugar-sweetened beverages alter purchasing behaviour of South African consumers? Perspectives of dietitians and key industry role-players

Background: The increasing prevalence of non-communicable diseases and obesity is associated with excessive consumption of sugar. To address this concern the taxation of sugar-sweetened beverages (SSBs), known as the Health Promotion Levy (HPL), was implemented in South Africa in April 2018. Objectives: A study was undertaken to investigate perspectives of dietitians and key industry role-players (KIRs) on the HPL. Design: This was a cross-sectional, descriptive study. Setting: A national study was conducted in South Africa via a virtual platform. Subjects: The participants were registered dietitians (n = 138) and key industry role-players (KIRs) (n = 39) who had expertise in nutrition, food science and/or sugar taxation legislation. Outcome measured: Electronic surveys probed participants’ awareness and opinions of the HPL, perceived SSB purchasing of consumers and barriers or facilitators for implementation of the HPL. Results: Dietitians were positive regarding the HPL (75.8%; n = 94/124) but regarded the tax as too little to affect a reduction in obesity (71.8%, n = 89/124). They reported a 19.2% reduction in their perceived clients’ daily purchasing of SSBs since implementation of the HPL. The KIRs regarded the HPL as insufficient to influence consumers’ purchasing behaviour (64.9%, n = 24/37). Consumers’ habitual purchasing was deemed a barrier (83.8%, n = 31/37) and consumer education an enabling factor (76,9%, n = 30/39) to successful implementation. Conclusion: Dietitians have a positive opinion on the HPL. They agree that the HPL alone will not influence the purchasing behaviour of consumers or reduce the prevalence of obesity. KIRs regard the HPL to be insufficient to affect consumers’ purchasing behaviour. The HPL should form part of a multi-pronged approach to create a supportive environment to reduce sugar consumption. It is recommended that approaches should include fiscal measures, consumer education and controlled marketing of SSBs. Trained dietitians would be able to enhance the goal of the HPL to combat the obesity pandemic.

Understanding the Knowledge, Attitudes, and Practices Concerning Sugar-Sweetened Beverages and Beverage Taxation among Saudi University Students.

University students should be informed about sugar-sweetened beverages (SSBs). Given the high consumption level of SSBs in Saudi Arabia, this study aims to examine the knowledge, attitudes, and practices related to SSBs and taxes. This cross-sectional study was conducted on 380 students at King Abdulaziz University in Jeddah between September 2022 and March 2023. The data were collected using an online self-administered questionnaire. The results reveal that 93% of the students had high knowledge scores, 99% have positive attitudes, and 37% present good practices toward SSBs. Moreover, 73% of students have high knowledge scores, 83% have positive attitudes, and 32% present good practices regarding SSB taxes. Each of these variables, college education, smoking, family income, body mass index, activities, and sports, showed statistically significant differences between gender with regard to the scores for knowledge, attitudes, and practice towards SSBs and their taxes. Thus, a high percentage of university students present sufficient knowledge of and good attitudes towards SSBs and taxation, unlike the practical results. Policymakers should develop strategic approaches and education campaigns to improve practices towards SSBs.

Impact of soda tax on beverage price, sale, purchase, and consumption in the US: a systematic review and meta-analysis of natural experiments.

As a primary source of added sugars in the US diet, sugar-sweetened beverage (SSB) consumption is presumed to contribute to obesity prevalence and poor oral health. We systematically synthesized and quantified evidence from US-based natural experiments concerning the impact of SSB taxes on beverage prices, sales, purchases, and consumption. A keyword and reference search was performed in PubMed, Web of Science, Cochrane Library, Scopus, and EconLit from the inception of an electronic bibliographic database to Oct 31, 2022. Meta-analysis was conducted to estimate the pooled effect of soda taxes on SSB consumption, prices, passthrough rate, and purchases. Twenty-six natural experiments, all adopting a difference-in-differences approach, were included. Studies assessed soda taxes in Berkeley, Oakland, and San Francisco in California, Philadelphia in Pennsylvania, Boulder in Colorado, Seattle in Washington, and Cook County in Illinois. Tax rates ranged from 1 to 2 ¢/oz. The imposition of the soda tax was associated with a 1.06 ¢/oz. (95% confidence interval [CI] = 0.90, 1.22) increase in SSB prices and a 27.3% (95% CI = 19.3, 35.4%) decrease in SSB purchases. The soda tax passthrough rate was 79.7% (95% CI = 65.8, 93.6%). A 1 ¢/oz. increase in soda tax rate was associated with increased prices of SSBs by 0.84 ¢/oz (95% CI = 0.33, 1.35). Soda taxes could be effective policy leverage to nudge people toward purchasing and consuming fewer SSBs. Future research should examine evidence-based classifications of SSBs, targeted use of revenues generated by taxes to reduce health and income disparities, and the feasibility of redesigning the soda tax to improve efficiency.

Seattle's sweetened beverage tax implementation and changes in interior marketing displays.

Policymakers aim sugar-sweetened beverage (SSB) taxes at decreasing SSB consumption; however, little is known about their impact on beverage marketing in the retail environment. We assessed changes in interior marketing displays within large food stores before and after the implementation of Seattle's SSB tax. We used Poisson difference-in-difference (DID) models to estimate whether presence and variety of interior beverage marketing displays in Seattle changed from before to after the tax compared to displays in non-taxed comparison area stores, overall, and by beverage type. We found no significant changes in overall SSB or non-SSB interior marketing displays in Seattle versus the comparison area. There was less of an increase in displays for diet soda (DID 0.79, 90% CI 0.65, 0.97), and more of an increase in displays for diet energy drinks (DID 1.78, 90% CI 1.03, 3.09) in Seattle versus comparison area. There was mixed evidence that stores changed interior marketing displays in response to the SSB tax.

Examining the Role and Strategies of Advocacy Coalitions in California's Statewide Sugar-Sweetened Beverage Tax Debate (2001-2018).

California's failed attempts to enact a statewide sugary beverage tax presents an opportunity to advance understanding of advocacy coalition behavior. We investigate the participation of advocacy coalitions in California's statewide sugar-sweetened beverage (SSB) tax policy debate. Document analysis of legislative bills and newspaper articles collected in 2019. California. A total of 11 SSB tax-related bills were introduced in California's legislature between 2001-2018 according to the state's legislative website. Data sources include legislative bill documents (n = 94) and newspaper articles (n = 138). Guided by the Advocacy Coalition Framework (ACF), we identify advocacy coalitions involved in California's SSB tax debate and explore strategies and arguments used to advance each coalitions' position. Two coalitions (public health, food/beverage industry) were involved in California's statewide SSB tax policy debate. The public health coalition had higher member participation and referred to scientific research evidence while the industry coalition used preemption and financial resources as primary advocacy strategies. The public health coalition frequently presented messaging on the health consequences and financial benefits of SSB taxes. The industry coalition responded by focusing on the potential negative economic impact of a tax. Multiple attempts to enact a statewide SSB tax in California have failed. Our findings add insight into the challenges of enacting an SSB tax considering industry interference. Results can inform future efforts to pass evidence-based nutrition policies.

Patterns and determinants of aerated drinks consumption among adolescents in India: analysis of National Family Health Survey-5 (2019-2021) data

PurposeThis study aims to investigate the consumption pattern of aerated drinks and examine its determinants among adolescents’ boys and girls (15–19 years) in India.Design/methodology/approachThe fifth round of National Family Health Survey (2019-2021) data was examined applying sample weights. Pattern of consumption and its determinants was analysed separately for boys and girls using binary logistic regression and calculating adjusted odds ratio (AOR) at 95% confidence interval.FindingsThe daily, weekly and occasionally consumption of aerated drinks was 4.4%, 22.7%, 63% for boys and 2.9%, 14%, 70.8% for girls, respectively. Factors such as secondary/higher education [Boys AOR = 1.5, (1.2–1.9) (p = 0.001); Girls AOR = 1.2, (1.1–1.2) (p < 0.001)]; rich wealth index [Boys AOR = 1.8, (1.6–2.1) (p < 0.001); Girls AOR = 1.3, (1.3–1.4) (p < 0.001)]; fried food consumption [Boys AOR = 11.1, (9.5–12.9) (p < 0.001); Girls AOR = 11.5, (10.8–12.3) (p < 0.001)]; and watching television [Boys AOR = 1.5, (2.3–1.7) (p < 0.001); Girls AOR = 1.3, (1.3–1.4) (p < 0.001)] were found significant predictors of aerated drink consumption among adolescents.Originality/valueThe authors noted differences in consumption pattern between adolescents’ boys and girls. A shift to occasional consumption from weekly and daily was also observed. A further decrease in consumption may requires gender and region-specific health-promotion interventions. Rationalising sugar-sweetened beverages taxation adhering World Health Organisation’s recommendation to reduce affordability may be further researched in the Indian context. Furthermore, sale and consumption of traditional and locally available fruits, vegetables and healthy beverages may be warranted.

How Could Taxes on Sugary Drinks and Foods Help Reduce the Burden Of Type 2 Diabetes?

Taxes on sugary drinks and foods have emerged as a key strategy to counteract the alarming levels of diabetes worldwide. Added sugar consumption from industrialized foods and beverages has been strongly linked to type 2 diabetes. This review provides a synthesis of evidence on how taxes on sugary products can influence the onset of type 2 diabetes, describing the importance of the different mechanisms through which the consumption of these products is reduced, leading to changes in weight and potentially a decrease in the incidence of type 2 diabetes. Observational studies have shown significant reductions in purchases, energy intake, and body weight after the implementation of taxes on sugary drinks or foods. Simulation studies based on the association between energy intake and type 2 diabetes estimated the potential long-term health and economic effects, particularly in low- and middle-income countries, suggesting that the implementation of sugary food and beverage taxes may have a meaningful impact on reducing type 2 diabetes and complications. Public health response to diabetes requires multi-faceted approaches from health and non-health actors to drive healthier societies. Population-wide strategies, such as added sugar taxes, highlight the potential benefits of financial incentives to address behaviors and protective factors to significantly change an individual's health trajectory and reduce the onset of type 2 diabetes worldwide, both in terms of economy and public health.

Pro- and Anti-Tax Framing in News Articles About California Sugar-Sweetened Beverage Tax Campaigns from 2014-2018

Sugar-sweetened beverages (SSB) contribute to illness, especially among marginalized communities and children targeted by the beverage industry. SSB taxes can reduce consumption, illness burden, and health inequities, while generating revenue for health programs, and as one way to hold the industry responsible for their harmful products and marketing malpractices. Supporters and opponents have debated SSB tax proposals in news coverage – a key source of information that helps to shape public policy debates. To learn how four successful California-based SSB tax campaigns were covered in the news, we conducted a content analysis, comparing how SSB taxes were portrayed. We found that pro-tax arguments frequently reported data to expose the beverage industry’s outsized campaign spending and emphasize the health harms of SSBs, often from health professionals. However, pro-tax arguments rarely described the benefits of SSB taxes, or how they can act as a tool for industry accountability. By contrast, anti-tax arguments overtly appealed to values and promoted misinformation, often from representatives from industry-funded front groups. As experts recommend additional SSB tax proposals, and as the industry mounts legislative counter-tactics to prevent them, advocates should consider harnessing community representatives as messengers and values-based messages to highlight the benefits of SSB taxes.

Examining attitudes toward a proposed sugar-sweetened beverage tax among urban Indigenous adults: a qualitative study using a decolonizing lens.

Sugar-sweetened beverage taxation has been proposed as a public health policy to reduce consumption, and compared with other ethnic or racialized groups in Canada, off-reserve Indigenous populations consume sugar-sweetened beverages at higher frequencies and quantities. We sought to explore the acceptability and anticipated outcomes of a tax on sugar-sweetened beverages among Indigenous adults residing in an inner-city Canadian neighbourhood. Using a community-based participatory research approach, we conducted semistructured interviews (November 2019-August 2020) with urban Indigenous adults using purposive sampling. Interviews were audio-recorded, transcribed verbatim and analyzed using theoretical thematic analysis. All 20 participants (10 female, 8 male and 2 two-spirit) consumed sugar-sweetened beverages on a regular, daily basis at the time of the interview or at some point in their lives. Most participants were opposed to and concerned about the prospect of sugar-sweetened beverage taxation owing to 3 interconnected themes: government is not trustworthy, taxes are ineffective and lead to inequitable outcomes, and Indigenous self-determination is critical. Participants discussed government's mismanagement of previous taxes and lack of prioritization of their community's specific needs. Most participants anticipated that Indigenous people in their community would continue to consume sugar-sweetened beverages, but that a tax would result in fewer resources for other necessities, including foods deemed healthy. Low support for the tax among urban Indigenous people is characterized by distrust regarding the tax, policy-makers and its perceived effectiveness. Findings underscore the importance of self-determination in informing health policies that are equitable and nonstigmatizing.