Beverage Tax Research Articles

Sugar Tax and its Implications on Health

Sugar Tax and its Implications on Health

The role of regressive sugar tax in the soft drink industry levy (SDIL): A Marxist analysis

Simmering beneath the bubbles of your regular soft drink are the issues of social class, subjugation, and social injustice. Sugar is a commodity and it is this component when added to soft drinks that now attracts a taxation liability under the Soft Drinks Industry Levy (SDIL) which was introduced in the UK in April 2018. In this critical taxation article, we argue that the UK’s capitalist state is using the excuse of concern with workers’ health to justify taxing a commodity, which is at best an authoritarian attempt to manage people’s behaviour to make it more conducive to capitalism, but will fail; add to economic inequality and inequity; and is therefore, morally delinquent.

Do sugar-sweetened beverage taxes improve public health for high school aged adolescents?

Sugar-sweetened beverage taxes have become an increasingly popular policy to combat the worldwide obesity epidemic, but relatively little is known about their impact on health outcomes, particularly among high school aged students. In this paper, I use public-use data from the Youth Risk Behavioral Surveillance Systemto determine whether high school students living in three of the American cities which have implemented Sugar-sweetened beverage taxes have experienced public health improvements. Using an event-study design that compares outcomes in treated districts to a group of similar control districts, I find reductions in soda consumption in Philadelphia and average body mass indexin Philadelphia, San Francisco and Oakland, with suggestive evidence that the improvements are concentrated among female and non-white respondents in both cases.

Corporate political activity in the context of sugar-sweetened beverage tax policy in the WHO European Region.

BackgroundSugar-sweetened beverage (SSB) taxes have emerged as an effective and increasingly popular tool to reduce added sugar intake, an important contributor to obesity and non-communicable diseases. A common barrier to the implementation of well-designed SSB taxes is the opposition of commercial actors. Focusing on the WHO European Region, this study seeks to map if and how key stakeholders have experienced industry efforts to influence SSB taxes.MethodsWe identified 11 countries in the WHO European Region which have implemented SSB taxes or attempted to do so. Using an online survey informed by the global literature on industry interference with SSB taxation, we approached 70 in-country policymakers, advocates and academics. The data were analysed using an existing framework of corporate political activity.ResultsTwenty-three experts from nine countries responded to the survey. Transnational SSB producers and their business associations were identified as the most active opponents of SSB taxation. Industry claims that the policy would have negative economic effects were identified as the most common and powerful arguments. Direct lobbying was reported in all study countries. Shifts in political activity were recognisable across stages of the policy process, moving from outright opposition to attempts to delay or weaken the policy after its announcement.ConclusionThose seeking to introduce effective SSB taxation can use our findings to pre-empt and counter industry opposition. We identify several measures for preventing and mitigating industry interference with SSB tax policy.

Spatial retail competition reduces the effects of soda taxes on price and quantity: Evidence from the Philadelphia Beverage Tax

We model and measure the economic response to taxes on sugar-sweetened beverages (SSB). We hypothesize that when the tax does not cover the geographic extent of the market, cross-border shopping by consumers reduces the pass-through rate of the tax and the effect of the tax on consumption. We further hypothesize that the multi-product nature of retail groceries compounds this competitive effect. We use retail scanner data and a difference-in-difference estimator to quantify effects of the Philadelphia Beverage Tax (PBT) implemented in 2017. We estimate a pass-through rate of 80 percent and a 32-percent reduction in SSB sales caused by the PBT. We find the tax increased sales and revenue of SSBs and of non-taxed products in stores close to Philadelphia but not subject to the tax. In addition, we find lower pass-through rates in stores offering a wider assortment of products. We take this as evidence that multiproduct competition reduces the effect of Philadelphia’s SSB tax. An important implication is that a tax implemented at the state or national level would be more effective at reducing SSB consumption.

Two countries, similar practices: the political practices of the food industry influencing the adoption of key public health nutrition policies in Guatemala and Panama.

To identify the corporate political activity (CPA) strategies used by food industry actors during the development of two public health nutrition policies in Central America: Law #570 (taxation of sugar-sweetened beverages) in Panama and Bill #5504 (labelling and food marketing regulations) in Guatemala. We triangulated data from publicly available information from 2018 to 2020, (e.g. industry and government materials; social media material) with semi-structured interviews with key stakeholders. Guatemala and Panama. Government, academia and international organisations workers in health and nutrition. CPA strategies were categorised according to an existing internationally used taxonomy into action-based, instrumental strategies (coalition management, information management, direct involvement and influence in policy, legal action) and discursive strategies. Instrumental strategies included the establishment of relationships with policymakers and direct lobbying against the proposed public policies. Discursive strategies were mainly criticising on the unfounded ground that they lacked evidence of effectiveness and will imply negative impacts on the economy. The industry pointed at individuals for making their own food choices, in order to shift the focus away from the role of its products in contributing to ill health. We provide evidence of the political practices used by the food industry to interfere with the development and implementation of public health nutrition policies to improve diets in Central America. Policymakers, public health advocates and the public should be informed about those practices and develop counterstrategies and arguments to protect the public and policies from the vested interests of the food industry.

The effect of soda taxes beyond beverages in Philadelphia.

Soda taxes are implemented in several cities across the United States (US) with the aim of reducing sugar intake from sugar sweetened beverages (SSBs). Sugar is linked to obesity and to higher risk of diabetes and cardiovascular conditions. Sodas are targeted with these taxes since they are the main source of sugar for consumers in the US. In presence of potential substitutes, the policy can be undermined by consumers changing their sources of sugar. We examine the heterogeneous effects of the 2017 Philadelphia soda tax on purchases of other items containing sugar. We present an empirical evaluation focusing on the potential substitution toward additional sugary foods in Philadelphia and counties bordering Philadelphia. We find an increase in sugar from purchases of sweetened foods of about 4.3% following the introduction of the tax in Philadelphia and of 3.7% in the neighboring localities. The substitution to sugary foods in Philadelphia offsets 19% of the decrease of sugar from SSBs. Additionally, we find that the substitution offsets 37% of the decrease of sugar from SSBs when including counties bordering Philadelphia. These results suggest that while SSB taxes might be effective at lowering consumption of SSBs, substitution patterns may limit the effectiveness of the tax to reduce overall sugar intake.

The ‘sugar tax’ in Bermuda: a mixed methods study of general population and key stakeholder perceptions

BackgroundTaxes on discretionary foods and sugar-sweetened beverages have emerged as a strategy for health promotion. Between 2018–2019, the Bermuda government introduced a phased tax on imported sugar-sweetened beverages, confectionery, products containing cocoa and pure sugar, and eliminated import duties on select healthy food items. The aim of this study was to conduct an mixed methods evaluation of perceptions of the tax among the general population and key stakeholders.MethodsWe conducted a survey of the general population (N = 400), and semi-structured interviews with key informants (N = 14) from the government, food and beverage, and health sectors to understand awareness, acceptability, and perceived impact of the tax after implementation. Survey data was analysed using thematic analysis, summary statistics, and Chi-squared tests. Key informant interviews were analysed using the framework method.ResultsGeneral population respondents had high awareness of the sugar tax (94%) but low awareness of the healthy food subsidy (32%). Most respondents (67%) felt the tax was not an appropriate way to motivate healthier consumption due to beliefs the tax would not be effective (44%), and because of the high price of healthy food (20%). However, nearly half (48%) reported consuming fewer taxed products, primarily for health reasons but also motivated by price increases. Key informants indicated there was high awareness but limited understanding of the tax policy. Informants expressed support for taxation as a health promotion strategy, conditional on policy implementation. The lack of clear price differentiation between taxed and un-taxed products and the absence of accompanying health education were key factors believed to affect the impact of the tax. No informants were aware of use of tax revenues for health purposes and tax revenue was reportedly re-directed to other priorities after implementation.ConclusionsThere was high awareness, but limited acceptability of the Bermuda sugar tax as implemented. Clarity in the tax policy, appropriateness of the tax mechanism, and use of revenue in alignment with the tax aim are critical components for acceptance. The absence of complementary education and health promotion affected acceptance and may limit potential health impacts. The lessons learned in Bermuda can inform similar policies in other settings.

Public perception of the tax on sweetened beverages in France.

To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance. A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling. NutriNet-Santé prospective cohort study. Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France. Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax. The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public.

The effects of a sugar-sweetened beverage tax: moving beyond dental health outcomes and service utilisation.

Despite considerable academic and policy interest in the taxation of sugar-sweetened beverages (SSBs), its extra-health implications remain largely unexplored. We investigated the impact of an SSB tax on school absenteeism due to improved dental health, in a framework that accounted for the distribution of the benefit. We designed a quantitative, decision-analytic model that synthesised existing evidence in the areas of dental epidemiology, public health and economics, and simulated causal mechanisms that lead to changes in school attendance in Australian children and adolescents aged 6-17, in a tax vs no tax scenarios. Introducing a 20% sales tax on SSBs would result in a 0.73% (95% confidence interval: 0.38; 1.10), or 4684 (2412; 7071) days per year nationwide, reduction in school absences attributable to dental health reasons. While positive impacts would be seen across the board, the distribution of benefit was favourable towards boys, older teens and those from lower socio-economic status. Our study highlights the need for, and the viability of, quantifying distributions of direct and indirect consequences of public health policy. Despite modest effect size, the equity profile of SSB tax, the long-lasting benefits of educational gains, and potential synergies with other interventions, make it an attractive option for policymakers to consider.

Implementation of sugar-sweetened beverages tax and its perception among public health stakeholders. A study from Poland

BackgroundOne of tools to tackle growing problem of overweight and obesity are the taxation mechanisms applied to sugar-sweetened beverages, which are expected to influence the common eating behaviors, but also they have impact on the market and public finances. The solution is therefore highly entangled in the complex of social and intersectoral interests generating a number of opportunities and threats affecting its feasibility.AimsThe study aims to depict the views of Polish stakeholders on the implementation of the sugar tax in Poland, particularly the perception of success determinants, barriers, as well as views on the features of the implemented solutions and possible alternatives.MethodsWe used semi-structured interviews with 18 individuals representing key public health stakeholders in Poland. The interview consisted of four parts, where first concentrated on the advantages and disadvantages of the SSB tax, the second part explored stakeholder involvement and stances, third concerned the feasibility of the project, and in the fourth part respondents were asked for suggestions for decision-makers regarding the content of the project and its implementation process. To reconstruct position of 4 main political parties we applied desk research. We used MAXQDA v2020 to analyse the collected data.ResultsStakeholders tend to expressed conflicting views on the effectiveness, relevance and socio-economic impact of the SSB tax. All of them agreed that the tax may appear severe for the poorest groups, children and adolescents, while disagreeing about the economic impact of the levy. The allocation of additional tax revenues was raising doubts, with stakeholders believing that the fiscal aim is the basic reason for implementing the tax, while these resources should be primarily dedicated to health promotion intervention and prevention of diet-related diseases. On the other hand, the political debate on the tax was highly superficial with strong populism arising of the presented positions.ConclusionsThere is a need to conduct a thorough public debate and improvements in terms of public communication to increase social awareness, sealing and refining the implemented solutions. Close cooperation with market players and non-governmental organizations is highly recommended.

Sugar taxation for climate and sustainability goals

Sugar taxation for climate and sustainability goals

Perceptions of the sugar-sweetened beverage tax amongst tertiary accounting students in South Africa: a comparative study

An excise tax on sugar-sweetened beverages to reduce excessive sugar consumption in South Africa came into effect on 1 April 2018. This study aimed to investigate perceptions of a limited sample of South Africans regarding the sugar-sweetened beverages tax based on certain economic factors, and whether participants perceived any likely benefit from the tax. These perceptions were compared with perceptions identified in selected foreign jurisdictions that have levied such a tax. A survey questionnaire was selected as the primary method of data collection. This questionnaire was administered to post-graduate Accounting students, aged twenty-one years and older, studying at three residential universities in South Africa. An extensive analysis of literature available on sugar-sweetened beverage taxes, both locally and internationally, was conducted. The two main constructs (construct 1: perception of the sugar-sweetened beverage tax and the price of sugar-sweetened beverages and construct 2: the social impact of the sugar-sweetened beverage tax) were analyzed using descriptive statistics. This study found that there is a significant association between gender and perception that the sugary beverage levy will be beneficial to health, with female perceptions of the benefit of the sugary beverage levy being greater than that of males. The study found that perception of the sugar-sweetened beverage tax may depend on several factors, closely linked to individual beliefs and cultures, and thus different populations may have different perceptions of the tax. The findings about sugar-sweetened beverage consumption trends across gender, ethnicities and physical activity groups can help guide targeted strategies to reduce consumption.

When do digital calorie counters reduce numeracy bias in grocery shopping? Evidence from an online experiment

PurposeNumeracy skills hinder a consumer’s ability to meet nutrition and calorie consumption guidelines. This study extends the literature on nutritional labelling by investigating how a calorie counter, which displays the total amount of calories consumers add to a shopping basket, aids them in making food choices. This study aims to ascertain whether the calorie counter affects food choices and also how individual and situational factors moderate this effect.Design/methodology/approachTo test the developed hypotheses, the authors designed an online shopping experiment and administered it to a national panel of British consumers. This included a sub-sample from the general population who did not report any food-related health conditions (n = 480) and a separate sub-sample from the same population who had reported a food-related health condition or lived with someone who had one (n = 250).FindingsThe results of this study show that the calorie counter leads to a large and statistically significant reduction in calories purchased when compared to the no nutritional information condition and a small (but statistically insignificant) reduction in the number of calories chosen by consumers when compared to the nutritional information only condition. The main effect is moderated by individual factors such as whether or not the person has a health condition and shopping situations which involve time pressure.Research limitations/implicationsAlthough the main effect of the calorie counter was not statistically significant when compared to the nutrition information only condition, the effect was in the correct direction and was statistically significant for consumers who had a food-related health condition. The conceptualisation and findings of this study are not only largely consistent with Moorman’s (1990) nutrition information utilisation process but also suggest that situational factors should be considered when understanding nutrition information processing.Practical implicationsThe findings from this study provide the first evidence to suggest that aggregating calorie information through a calorie counter can be a useful way to overcome consumer numeracy biases, particularly for those with existing health conditions and who are most motivated to use nutritional information. Based on the descriptive statistics, the main effect was comparable to the UK’s sugar tax in its impact and the authors estimate this would lead to a reduction in calories consumed of about 5,000 per year, even for consumers who did not report a health condition. Further testing is required with different formats, but these results are encouraging and are worthy of further research.Originality/valueTo the best of the authors’ knowledge, this is the first study to investigate how consumers react to aggregated nutritional information for a basket of products, mimicking a real shopping situation. Such information has the potential to become more relevant and useful to consumers in the context of their overall diets. As technology advances rapidly, there is a need to explore alternative ways of presenting nutritional information, so it connects more easily with consumers. These results point very much to a more targeted and personally relevant approach to information provision, in contrast to existing mass communications approaches.

The relationship between volume of newspaper coverage and policy action for nutrition issues in Australia: a content analysis

ObjectivesUnhealthy diets are a leading risk factor for the global burden of disease. Research suggests that comprehensive, population-level solutions are required to attenuate this problem, though such policies have not been adopted. Increased media attention may lead to government-led policy action through issue definition and agenda setting. The aim of this study was to analyse which nutrition policy issues are covered in print media, and whether media attention correlated with relevant policy actions in Australia. Study design/methodsA content analysis was conducted on newspaper articles published between 1999 and 2019 from 11 major Australian metropolitan newspapers. ResultsOf the policy issues identified, few received meaningful media attention. Of those with peaks in media attention, only fortification and labelling issues coincided with government-led policy actions, while regulating junk-food advertising to children, sugar-sweetened beverage taxation, and the formulation of a National Nutrition Policy did not result in policy outcomes. ConclusionsGiven the limited coverage of nutrition policy issues, the relationship between media attention and policy actions for the captured issues may not be determinable. In addition, factors including social, political, and historical contexts may be stronger influences on policymaking than media attention. Although this study did not demonstrate a relationship between media attention and policy action because of low coverage of nutrition issues, it did identify the media are generally reporting nutrition policy issues with a positive public health framing. Promoting favourable coverage of nutrition policy issues is still an important tool for advocacy globally. Moving forward, increasing the volume of coverage of nutrition issues should be an advocacy priority.

Relation between the food environment and oral health-systematic review.

BackgroundThere is increasing evidence that the food environment, i.e. the availability, accessibility, price and promotion of foods and beverages, has a significant influence on oral health through food consumption. With this systematic literature review, we systematically summarize the available evidence on relations between the food environment and oral health outcomes in children and adults.MethodsEnglish-language studies were identified through a systematic literature search, executed by a medical information specialist, on OVID/Medline, Embase, Web of Science and CINAHL. Title and abstract screening, full-text screening and quality assessment [using the Quality Assessment with Diverse Studies (QuADS) tool] were done independently by two authors.ResultsTwenty-three studies were included, of which 1 studied the consumer food environment (food labeling), 3 the community food environment (e.g. number of food stores in the community), 5 the organizational food environment (availability of healthy foods and beverages in schools), 2 the information environment (television advertisements) and 13 government and industry policies related to the food environment (e.g. implementation of a sugar-sweetened beverage tax). Almost all studies found that unhealthy food and beverage environments had adverse effects on oral health, and that policies improving the healthiness of food and beverage environments improved—or would improve in case of a modeling study—oral health.ConclusionsThis systematic literature review provides evidence, although of low to moderate quality and available in a low quantity only, that several aspects of the food environment, especially policies affecting the food environment, are associated with oral health outcomes.

P25 Income and Equity Effect of Modelled Sugar Tax and Fruit and Vegetable Subsidy Program across Different Income Groups in Canada

Food taxes and subsidies have been implemented in many countries, and they have effectively improved the dietary patterns of populations and reduced disease risks, enhanced quality of life, and saved healthcare costs. However, the equity consequences of these interventions are not well understood. This study aims to assess the impact of sugar tax and fruit and vegetable subsidy programs on future health care spending for chronic disease management and treatment by income quintiles in Canada.

Examining the policy process of sugar-sweetened beverage taxation in Ireland

Sugar sweetened beverages (SSBs) are a growing source of weight gain, obesity, and type 2 diabetes that contain high added sugar amounts and provide minimal nutritional benefit. Taxing SSBs are effective in reducing sugar consumption and increasing awareness about health effects. The 2014 European Union Action Plan on Childhood Obesity combined with neighboring SSB tax proposals in the U.K. and France helped stimulate political discussions in Ireland. Following this momentum, in 2015, public health groups lead by the Irish Heart Foundation proposed an SSB tax with earmarked funds for public health and worked with the Irish Health Department through a whole-of-government approach to convince the Finance Department to introduce an SSB tax. These efforts resulted in the Finance Department proposing the Sugar Sweetened Drinks Tax (SSDT) in September 2016, which taxes non-alcoholic, water-based and juice-based drinks, which have an added sugar content of 5g per 100mL and above. Opposing stakeholders including the Irish Beverage Council and Food & Drink Industry Ireland argued that the tax would not decrease consumption of SSBs or impact obesity, disproportionately impact individuals with a low socioeconomic background, and create illicit trade. However, health groups argued the tax would reduce sugar consumption, encourage consumers to purchase healthier options, and help reduce obesity levels. These efforts with political will helped Ireland become the 36th country in the world (9th in Europe) to implement an SSB tax policy in May 2018. While the government reportedly raised €16.5 million (20.012 million USD) in 2018 and €33 million (40.024 million USD) in 2019 from the SSDT, the tax was not earmarked for public health purposes nor has it been evaluated despite multiple requests by public health groups representing an important missed opportunity. While other countries should follow Ireland's lead in enacting an SSB tax, it is important to evaluate the tax's impact on reducing sugar consumption and ensure the tax has earmarked funds for public health to further maximize the impact of reducing sugar consumption, promoting health equity and helping curb the NCD epidemic.

Sweetened beverage taxes: Economic benefits and costs according to household income

Taxing sweetened beverages has emerged as an important and effective policy for addressing their overconsumption. However, taxes may place a greater economic burden on people with lower incomes. We assess the degree to which sweetened beverage taxes in three large US cities placed an inequitable burden on populations with lower incomes by assessing spending on beverage taxes by income after taxes have been implemented, as well as any net transfer of funds towards lower income populations once allocation of tax revenue is considered. We find that while lower income populations pay a higher percentage of their income in beverage taxes, there is no difference in absolute spending on beverage taxes per capita, and that there is a sizable net transfer of funds towards programs targeting lower income populations. Thus, when considering both population-level taxes paid and sufficiently targeted allocations of tax revenues, a sweetened beverage tax may have characteristics of an equitable public policy.

Outcomes Following Taxation of Sugar-Sweetened Beverages

More than 45 countries and several local jurisdictions have implemented sugar-sweetened beverage (SSB) taxes to improve nutrition and population health, and evidence on their outcomes to date is essential to inform policy discussions. Responding to this need, the World Health Organization commissioned a systematic literature review on the outcomes of fiscal policies, including SSB taxes. To assess the associations of implemented SSB taxes with prices, sales, consumption, diet, body weight, product changes, unintended consequences, health, and pregnancy outcomes. Searches of 8 bibliographic databases (Business Source Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EconLit, PsycINFO, PubMed, and Scopus) were performed from database inception through June 1, 2020, with no language or setting restrictions. Grey literature was assessed using 14 sources and government websites. The review included primary studies of implemented SSB taxes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. For prices, sales and consumption, results were meta-analyzed using a 3-level random-effects model. Study quality was assessed at the outcome level. Tax pass-through rate for prices, percentage reduction in SSB demand, and price elasticity of demand for sales and consumption. Heterogeneity was assessed using τ2 and the I2 statistic. A total of 86 articles were eligible, with 62 studies contributing to the meta-analysis. The overall tax pass-through rate was 82% (95% CI, 66% to 98%; P < .001, I2 = 99%), suggesting tax undershifting. The demand for SSBs was highly sensitive to tax-induced price increases, with the price elasticity of demand of -1.59 (95% CI, -2.11 to -1.08; P < .001; I2 = 100%) and a mean reduction in SSB sales of 15% (95% CI, -20% to -9%; P < .001; I2 = 100%). There was no evidence of substitution to untaxed beverages, and changes in SSB consumption were not significant. The narrative synthesis found reformulation and reduced sugar content of taxed beverages for tiered taxes, cross-border shopping in most studies of local-level taxes, and no negative changes in employment. Data on the heterogeneity of SSB tax outcomes across subpopulations were limited. In this systematic review and meta-analysis of implemented SSB taxes worldwide, SSB taxes were associated with higher prices and lower sales of taxed beverages.