health impact of taxes on foods high in fat, sugar, salt...what are taxes aimed at? •tax as a...
TRANSCRIPT
Health Impact of Taxes
on Foods High in Fat, Sugar, Salt
Franco Sassi PhD Imperial College London
WHO, Geneva, 4th-5th December 2017
What Are Taxes Aimed at?
• Tax as a signal to consumers and industry
• Reduce the consumption of a specific product
• Improve health by improving dietary quality
• “research on the overall nutritional quality of purchases is mixed
because of substitution effects” (Epstein et al. 2012)
• “Food substitutions are difficult to investigate and predict, and they
may hinder the effectiveness of taxes when the latter are not
carefully designed.” (Hawkes and Sassi, 2015)
Taxing Fat
• UK – “negligible” effects (Tiffin and Arnoult, 2011)
• France – “small and ambiguous” effects (Allais et al., 2010)
• Potential unwarranted substitutions:
o Increased sugar intake (Jensen and Smed, 2007)
o Increased salt intake (Mytton et al., 2007)
• Politically difficult and controversial:
o Hits products viewed as basic components of diet (meat, dairy, etc.)
o How bad is fat?
The Danish Saturated Fat Tax 2011-12
• Reduction in saturated fat intake from beef by 1.4% (with
increased consumption of low- and medium-fat cuts), and from
cream by 11.3% (Jensen et al., 2014)
• Overall intake of saturated fat reduced by 4% (Smed et al., 2016), along
with increased consumption of vegetables and salt, leading to a
0.4% reduction in all deaths from NCDs (modelled)
• Estimates of change in IHD risk vary from +0.2% to -0.3% (Bødker et
al., 2015)
• Lack of scientific consensus on health value of the tax key reason
behind repeal (Holm et al., University of Copenhagen)
Fat Taxes Work Best when Coupled with Subsidies
• Review of effects of population-level subsidies (Thow et al., 2010)
• Review of model-based studies (Eyles et al., 2012)
• Subsidy component has larger effect than tax component (Tiffin and
Arnoult, 2011)
• But is also more regressive (Lacroix et al., 2010)
Health Outcomes of Combined Tax and Subsidy (Cecchini et al., 2010)
Mass media camp
Worksite interv.
Physician couns.
School-based int.
Food labelling
Fiscal measures
Food advert reg.
Life years (thousands)
China India Brazil Russian Federation England Mexico South Africa
Combined Taxes and Subsidies: Distributional Impacts
0.0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
0.7%
high SES low SES
Disadvantaged socio-
economic groups will
benefit the most in health
terms because:
a) they are more price
responsive
b) they have a larger
prevalence of chronic
diseases and risk factors
DALYs Saved by Age Group
Source: OECD Health Working Paper 48.
Do Subsidies Alone Work?
• Good evidence on fruit and vegetable subsidies
• Sweden – wholegrain subsidies lead to increased intake, but
mostly in existing consumers, and also increased consumption of
salt and fat (Nordström and Thunström 2009, 2011)
• Risks in subsidising foods or nutrients:
o Increase in overall calorie intake
o Increase in unhealthy nutrient intake
o Unwarranted change in the overall balance of macro-nutrients
• Product subsidies vs. welfare subsidies – evidence of perverse
effects of food stamps in US
Taxing Energy or Energy Density
• Calorie tax – modelled, but never tried in practice; most efficient
option (Okrent and Alston, 2012), but not always most effective
• Several countries have taxed energy-dense, “non-essential”, or
“nutrient-poor” foods (e.g. Hungary, Finland, Mexico and others)
• Hungary evaluations positive, but largely qualitative and based on
surveys (self-reports) – the tax has led to substitutions towards
healthier products and product reformulation by manufacturers
• Mexico early evidence – consumption of taxed foods reduced by
5.1% relative to expected levels (-10.2% for low-SES households) in
the first year (Batis et al., 2016)
Taxing Energy or Energy Density
• Fast food prices leading determinant of adolescent body weight (Powell
et al., 2006)
• Price elasticity of fast food consumption -0.52 (Powell et al., 2012)
• Significant body of research based on laboratory choice experiments:
evidence that price incentives can improve overall nutritional quality
of food choices, but highly dependent on substitutions
Can we Tax based on Nutrient Profiles?
• Increasing focus on nutrient profiling to improve overall dietary
quality
• Studies combining nutrient profiles for different foods into an overall
score for diets show some degree of correlation with health
outcomes, but variable for different outcomes (Julia et al.)
• Norfolk EPIC study: no correlation of overall dietary score with CVD
and other health outcomes (Rayner et al.)
• Challenges in tax administration and political acceptability (industry,
trade organisations)
Conclusions
• Taxes on food and non-alcoholic beverages can:
o Give a signal to consumers and manufacturers
o Reduce consumption of taxed product
• So, they should focus on products that can be singled out as
unhealthy and of no or limited nutritional value
• Using taxes to improve nutritional quality of overall diet is much more
challenging, and we may not have the tools and the political drive
required to do it today