local ordinances and regulations - feasibility, challenges...
TRANSCRIPT
Local Ordinances and Regulations - Feasibility, Challenges and Impact The Cases of Taxes on Sugar Sweetened Beverages and Warning Labels
A Workshop on Strategies to Limit Sugar-Sweetened Beverage Consumption in Young Children: Evaluation of Federal, State, and Local Policies and Programs National Academy of Science Washington, DC, June 21, 2017
Lynn Silver, MD,MPH, FAAP Senior Advisor
Public Health Institute Clinical Professor
University of California San Francisco
• Fiscal Measures:
• Taxation (Berkeley, Navajos, Oakland, San Francisco, Philadelphia, Boulder, Albany, Cook County, Seattle)
• SNAP demonstrations proposals excluding SSBs (NYC proposed, blocked)
• Labeling/ Warnings labels
• Place Based: • Day Care - Main strategy assessed in 0-5 year olds (Example NYC). • Schools • Workplaces • Public procurement
• Product modifications:
• Portion caps/ Big gulp laws (NYC, blocked, but still legal to do elsewhere)
• Food service/ kids meals laws (multiple locations)
• Retail environment change - for example less favorable placement of SSBs, healthy checkouts, not yet legislated
• Restrictions on Marketing to children - not advancing much in US as local regulations, progress at USDA
• Encouraging broader cultural shifts from highly processed foods to “real” foods and drinks: move from “nutrient based” standards to promoting whole or minimally processed foods. Farm to school.
Approaches to Local Sugar Sweetened Beverage Regulation
Spread of Sugar Sweetened Beverage Taxes: Success Replacing Defeat
pre-2009 2010 2011 2012 2016 2015 2014 2013 2009
UK Philadelphia
Oakland Albany (CA)
San Francisco Cook County
Boulder India
South Africa Colombia
Illinois California
Barbados Dominica Belgium Ecuador
USA California Vermont Illinois
Connecticut Puerto Rico
Chile St. Helena
Berkeley,CA Navajo Nation
San Francisco Vermont
Connecticut
Australia Denmark French
Polynesia Ireland Nauru
Norway Samoa
Fiji Finland
Arizona California
Connecticut Hawaii Illinois
Massachusetts Mississipi
New Mexico Oregon
Rhode Island Tennessee
Texas Utah
Vermont West Virginia Philadelphia
Hungary France Hawaii
Mississipi Nebraska
Rhode Island Vermont
West Virginia Richmond CA El Monte CA
Cook Islands
Mauritius Mexico Tonga
California Hawaii
Connecticut Mississipi New York Oregon
Rhode Island Texas
Vermont West Virginia
Chicago Telluride CO
Hawaii Massachusetts
New York Rhode Island
Arizona California
Connecticut Hawaii Kansas Maine
Mississipi New Hamshire New Mexico
New York Rhode Island
Washington, DC Philadelphia
Source: World Cancer Research Fund, www.Kickthe can.onfo, Chriqui 2013.
Green = Passed Grey = Pending Orange= Failed
2017
Catalunya
Seattle Multnomah
India South Africa
Santa Fe California
SSB Tax Logic
• \
SSB Excise Tax
Δ Price
ΔConsumption (or reformulation)
ΔQALY’s Δ DALY’s ΔHealth
Care Costs
ΔObesity
Modified from Gortmaker, 2016
Revenue Social Investment and Change
Jurisdiction Level of Tax
Products Covered Use
San Francisco Oakland Berkeley
Albany (CA)**
1¢ per ounce
SSBs only >25 cal/12 oz
>=2cal/oz
General taxes with Advisory Committees or input guiding spending for health, obesity
and diabetes prevention
Navajo Nation 2% sales tax
Sweetened beverages and food of minimal
nutritional value
Community Wellness Fund
Boulder (CO) 2¢ per ounce
SSBs only with >=5gms added sweetener per 12
oz
Dedicated to health promotion, wellness and
chronic disease prevention
Philadelphia (PA) 1.5¢ per ounce
SSBs and artificially sweetened beverages
Pre-Kindergarten Education
Cook County (IL) 1¢ per ounce
SSbs and non-calorically sweetened beverages
General revenue, covering public safety and health
needs
Seattle (WA) 1.75¢ SSBs only >=40 cal/12 oz Childhood education & healthy food, water access, support to
people with diabetes and obesity
SSB Taxes Approved in US 2014-2017
Local SSB Tax Findings • 21 % decrease in SSB consumption in street intercepts conducted in low-income neighborhoods in first 4
months relative to pre-tax (p=0.46), vs. +4% increase in comparison sites, +63% increase in water (Falbe et al, AJPH 2016)
• 9.6% decline (p < 0.001) in SSB sales (oz. per transaction) in Berkeley in full first year analysis of 15.5 million scanner checkout episodes in 2 chains from Berkeley and comparison sites, compared to predicted. • increase in overall beverage sales in Berkeley • 3.5% increase versus 0.5% (both p < 0.001) for non-Berkeley stores in untaxed beverage sales • May be some leakage of sales to nearby stores.
• No increase in average grocery bill in these chains, nor greater decline in store revenue per transaction in Berkeley
• Compatible but not significant decline in SSB kcal/d from 45 to 39 kcal/d (−19.8%, p = 0.56) and in smaller telephone survey of 957 adults. Some caloric increase from untaxed beverages.
• +0.67¢/oz (p = 0.00) pass-through of 1 ¢/oz tax to taxed beverages in scanner data
• Data consistent with Mexico findings of a 6% decrease in SSB sales in Year 1 and increasing water sales. (Colchero et al, BMJ, 2015); -7.3% in Years 1-2 (Colchero, PLoS One, 2016)
• Price elasticity consistent with published estimates
Source: Silver & Ng, et al, PLOS Med 2017
Key Findings from Evaluations of Berkeley Soda Tax
Water up +15.6% Milk up +1% Diet down -9.2%
Key Findings
Beverage Substitutions in Berkeley In First Tax Year (Point of Sale Mean Daily Adjusted Volume (oz. per transaction)
Source: Silver & Ng, et al PLOS Medicine 2017
Local SSB Tax Findings • Raised $13 dollars per capita per annum even with Berkeley’s consumption
only 1/3rd of national average (45 kcal/d in US vs. 131 kcal/d) . Used for health promotion.
• While limited by observational design, suggest SSB taxes may be effective in shifting consumers to healthier beverages without undue economic hardship and while raising revenue for social objectives
• No data on children yet
• No data yet on impact of revenue use
• Qualitative research did not find major barriers to implementation but did identify areas for improvement
• Multiple evaluations underway or proposed for new SSB taxes
Source: Silver & Ng, et al, PLOS Med 2017
Key Findings from Evaluations of Berkeley Soda Tax
Key Findings
Did soda tax hurt Berkeley business? No Evidence
Source: Silver, 2017
Key Findings
Did soda tax hurt Berkeley business? No Evidence
Source: Silver, 2017
Key Findings The Uber Driver
African American in her 60s lived 40 years in Berkeley. She voted for Berkeley’s soda tax after some hesitation.
She went to the doctor. and was told she has pre-diabetes. She was referred to the 16 week Diabetes Prevention
Program at the YMCA. She went and learned how to eat differently
She asked: “How much does it cost?” The YMCA said “Nothing”
She asked “Why?” “Because the City (of Berkeley) is paying with the
soda tax money” She went back to the doctor.
Her blood sugar had gone down And it is still down.
Local SSB Tax Findings Two models of local laws in US
• On products, much stronger model, not passed anywhere, defeated in California and in New York State.
• On certain SSB print advertising - passed in San Francisco in 2015, held up in court still. Most likely to reduce point of sale SSB ads
Two models in global use:
• Black Octagon in Chile High Sugar Front of Pack warning (proposed in Uruguay and Argentina)
• Traffic Light for High Sugar Ecuador (Bolivia regulation pending, EU has variation)
Warning Labels
San Francisco Warning Label on Advertising Model
WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco
Local SSB Tax Findings • Real Life: Underway - San Francisco baseline and comparison city
advertising and consumption data collected, awaiting implementation of law for follow up.
• Experimental studies:
• Adolescents are less likely to chose an SSB if it carries a warning (61-65%) than in the no label (77%) condition. (Van Epps, AJPM, 2016)
• Parents Online simulation survey n=2381 (Roberto, Pediatrics 2016)
• Fewer parents chose an SSB for their child in the warning label condition (40%) versus the no label (60%) and calorie label conditions (53%).
• Parents in the warning label condition also chose significantly fewer SSB coupons, believed that SSBs were less healthy for their child, and were less likely to intend to purchase SSBs.
Warning Labels - Evaluation
Warning Labels - Another Strong Option: Chile’s High Sugar Front of Pack Warnings
Study in children 8-13 in Uruguay found the warning octagon
effective in discouraging choice, more than the traffic light model, other evaluations underway
Source: Universidad de la República and Instituto Nacional de Alimentación/MIDES of Uruguay, presented 2016 - unpublished
Ecuador’s Traffic Light Warning
Model
Ecuador’s Traffic Light Warning Model and SSB Reformulation
In Summary: • Many local measures are legally and technically feasible
• Building understanding, community support and political feasibility is the greatest obstacle
• Evaluations of SSB taxation in Mexico and Berkeley suggest effectiveness. Study of additional sites and models (tiered, proportional to sugar, higher taxes), and longer term health impact will further advance understanding.
• Caloric impact needs further study in more typical populations
• Negative warning labels, particularly on products, are a promising strategy
• No real life data on children for taxation or warning labels yet
• Local strategies likely to act synergistically
Like Smoke Free Air
Ridiculous Possible Normal Tarja Halonen, former President, Finland
new ideas go from
Thank you [email protected]