Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor

The Effects of Subsidies for Healthy Foods on Food Purchasing Behaviors, Consumption Patterns, and Obesity/Overweight: A Systematic Review

CONTEXT

Taxing unhealthy foods and drinks is an essential measure against the double burden of malnutrition that affects every nation worldwide. In turn, subsidizing the consumption of healthy foods can also be a critical measure for changing the population's behavior and improving health indicators.

OBJECTIVE

A systematic review was conducted of food subsidies and their potential impact on food purchases, consumption, overweight/obesity, and changes in body mass index (BMI).

DATA SOURCES

The PubMed, Embase, LILAC, Scientific Electronic Library Online, and Google Scholar databases were searched to identify studies investigating the effects of subsidies on the amount of food purchased, food consumption, caloric intake, nutrient intake, and their impact on overweight, obesity, and BMI changes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

DATA EXTRACTION

Two investigators independently performed data screening, extraction, and quality assessment.

RESULTS

Of the 6135 studies screened, 149 were read in full and 18 were included in this systematic review. Most studies investigated the effects of subsidy scenarios on food purchases and observed increases in fruit and vegetable (F&V) purchases when these were subsidized. In randomized controlled studies, subsidized healthy foods were purchased more often. However, when the subsidy was suspended, F&V consumption decreased. Although quasi-experimental studies have demonstrated increased F&V consumption due to subsidies, some studies showed increased saturated fat and sodium intake. Only 2 studies evaluated the relationship between subsidies and obesity, yielding conflicting results.

CONCLUSION

Although the subsidies appear to encourage purchase and consumption of healthier foods, enhancing the quality and diversity of dietary choices, the removal of subsidies can lead to a decline in the consumption of healthier foods. Additionally, their impact on obesity and BMI remains uncertain and requires further research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration by the number CRD42023442122.

Daily Sugar-Sweetened Beverage Intake and Its Association with Undiagnosed Non-Communicable Diseases Among Malaysian Adults: Findings from a Nationally Representative Cross-Sectional Study

Background/objective: We examined the prevalence of daily sugar-sweetened beverage (SSB) intake, identifying its sociodemographic determinants and exploring its potential association with undiagnosed non-communicable diseases (NCDs) among Malaysian adults. Methods: This cross-sectional study analyzed data from 6596 Malaysian adults participating in the 2019 National Health and Morbidity Survey (NHMS). Multiple logistic regression was used to examine the association between daily SSB intake and the risk of undiagnosed diabetes, hypertension, hypercholesterolemia, and obesity while adjusting for potential confounders. Results: The prevalence of daily SSB intake was 53.6%, with higher intake observed among females, older adults, Indians, and unemployed individuals. After adjusting for confounders, daily SSB intake was not significantly associated with undiagnosed diabetes (adjusted OR: 1.01, 95% CI: 0.80-1.29), undiagnosed hypertension (adjusted OR: 0.99, 95% CI: 0.81-1.22), undiagnosed hypercholesterolemia (adjusted OR: 0.99, 95% CI: 0.83-1.18), or obesity (adjusted OR: 1.08, 95% CI: 0.91-1.27). Conclusions: This study highlights the high prevalence of daily SSB intake among Malaysian adults, driven by sociodemographic factors. While a lack of direct associations with undiagnosed NCDs was observed, the high prevalence of SSB intake raises concerns about long-term health impacts. Targeted public health interventions are essential to address the cultural and economic determinants of SSB intake, as well as future research adopting longitudinal designs to explore how sustained reductions in SSB intake influence the risk of developing NCDs.

Simulating price subsidies on healthy foods in Mexico

OBJECTIVE

To simulate the impact of a price subsidy (price reduction) on purchases of healthy foods with suboptimal consumption.

DESIGN

We used data from the 2018 Mexican National Household Income and Expenditure Survey, a cross-sectional study. We estimated own- and cross-price elasticities of the demand for food groups using a Linear Approximation of an Almost Ideal Demand System. Using the estimated elasticities, we derived changes in purchases associated with a 10, 20 and 30 % price reduction in healthy food groups with suboptimal consumption. We also estimated price reductions for these food groups that would meet the recommendations of the Healthy Reference Diet (EAT-HRD) proposed by the EAT-Lancet commission.

SETTING

Mexico (country).

PARTICIPANTS

A nationally representative sample of mexican households.

RESULTS

Price reductions were associated with increases in the quantity purchased, ranging from 9·4 to 28·3 % for vegetables, 7·9 to 23·8 % for fruits, 0·8 to 2·5 % for legumes and 6·0 to 18·0 % for fish. Higher reductions in prices would be needed to achieve the EAT-Lancet Commission's recommendations for food groups with suboptimal consumption in Mexico: a 39·7 % reduction in prices for fruits, 20·0 % for vegetables and 118·7 % for legumes.

CONCLUSIONS

Our study shows that reductions in prices can lead to increases in purchases of healthier food options. More research is needed to assess the most cost-effective strategy to deliver subsidies using either conditional cash transfers, vouchers or food baskets provided to families or direct subsidies to producers.

Examining the 2021 Cash Value Benefit Increase and WIC Participant Food Purchases

INTRODUCTION

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritious foods to more than six million low-income families. In June 2021, WIC increased the amount of money provided for fruits and vegetables (FV), but studies have not investigated whether this increase changed WIC participant FV purchases. The objective was to estimate the association between the FV funding increase and WIC shopper FV purchases.

METHODS

This evaluation uses longitudinal food transaction data from 496 stores in a grocery store chain in North Carolina between June 2020 and April 2022 and a propensity score weighted difference-in-differences (DID) approach to estimate the association between the FV funding increase and FV and other food group purchases. Analyses were conducted in 2023 and 2024.

RESULTS

WIC shoppers' WIC-eligible FV purchases increased by $12.4 per shopper per month (adjusted confidence interval [ACI], $12.0-$12.9) after the FV benefit increase, which was $9.3 (ACI, $8.7-$10.0) more than non-WIC shoppers. The monthly volume and unique varieties of FV purchased also increased more among WIC shoppers relative to non-WIC shoppers (DID 67.1 ounces [ACI, 61.9-72.3] and DID 2.1 varieties [ACI, 2.0-2.3]). There were also increases in the volume of processed foods (DID 22.0 ounces [ACI, 17.2, 26.9]) and sugar-sweetened beverages (DID 49.1 ounces [ACI, 33.4, 64.9]) purchased among WIC shoppers relative to non-WIC shoppers.

CONCLUSIONS

Increased WIC FV funding was associated with greater FV purchases. Research is needed to understand the effects of this policy on total dietary intake.

Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income

INTRODUCTION

Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households.

METHODS

The 2017-2018 packaged food purchase data among U.S. households were used to derive household income- and composition-specific demand elasticities across 22 food and beverage categories. Policy simulations, conducted in 2022-2023, assessed the impact of national taxes on unhealthy ultraprocessed food and beverage purchases, both separately and alongside subsidies for minimally processed foods and beverages targeted to low-income households. Resultant nutritional implications are reported on the basis of changes in purchased calories and nutrients of concern. In addition, financial implications for both households and the federal government are projected.

RESULTS

A sugar-based tax on sugar-sweetened beverages would lower both volume and calories purchased with the largest impact on low-income households without children. Meanwhile, targeted subsidies would increase fruit, vegetable, and healthier drink purchases without substantially increasing calories. Under tax simulations, low-income households would make larger reductions in their absolute volume and calorie purchases of taxed foods and beverages than their higher-income counterparts, suggesting that these policies, if implemented, could help narrow nutritional disparities.

CONCLUSIONS

Levying national taxes on unhealthy ultraprocessed foods/beverages and offering targeted subsidies for minimally processed foods/beverages could promote healthier food choices among low-income households. Such policies have the potential to benefit low-income households financially and at a relatively low cost for the federal government annually.

The equitable impact of sugary drink taxation structures on sugary drink consumption among Canadians: a modelling study using the 2015 Canadian Community Health Survey-Nutrition

OBJECTIVE

Estimate the impact of 20 % flat-rate and tiered sugary drink tax structures on the consumption of sugary drinks, sugar-sweetened beverages and 100 % juice by age, sex and socio-economic position.

DESIGN

We modelled the impact of price changes - for each tax structure - on the demand for sugary drinks by applying own- and cross-price elasticities to self-report sugary drink consumption measured using single-day 24-h dietary recalls from the cross-sectional, nationally representative 2015 Canadian Community Health Survey-Nutrition. For both 20 % flat-rate and tiered sugary drink tax scenarios, we used linear regression to estimate differences in mean energy intake and proportion of energy intake from sugary drinks by age, sex, education, food security and income.

SETTING

Canada.

PARTICIPANTS

19 742 respondents aged 2 and over.

RESULTS

In the 20 % flat-rate scenario, we estimated mean energy intake and proportion of daily energy intake from sugary drinks on a given day would be reduced by 29 kcal/d (95 % UI: 18, 41) and 1·3 % (95 % UI: 0·8, 1·8), respectively. Similarly, in the tiered tax scenario, additional small, but meaningful reductions were estimated in mean energy intake (40 kcal/d, 95 % UI: 24, 55) and proportion of daily energy intake (1·8 %, 95 % UI: 1·1, 2·5). Both tax structures reduced, but did not eliminate, inequities in mean energy intake from sugary drinks despite larger consumption reductions in children/adolescents, males and individuals with lower education, food security and income.

CONCLUSIONS

Sugary drink taxation, including the additional benefit of taxing 100 % juice, could reduce overall and inequities in mean energy intake from sugary drinks in Canada.

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.

Importance of Nutrition Security to CVD Prevention Efforts in the USA

PURPOSE OF REVIEW

The importance of addressing nutrition security for the primary and secondary prevention of cardiovascular disease (CVD) in the USA is reviewed by describing the relationships between food security, diet quality, and CVD risk along with the ability of governmental, community, and healthcare policies and interventions to address nutrition security.

RECENT FINDINGS

Existing safety net programs have shown to be effective at improving food security and diet quality and reducing risk for CVD, but continued efforts to increase reach and improve standards are needed. Adoption of policies, healthcare initiatives, and community- and individual-level interventions addressing the nutritional intake of socioeconomically disadvantaged populations may also lessen CVD burden, but scaling interventions remains a key challenge. Research suggests simultaneously addressing food security and diet quality is feasible and could help reduce socioeconomic disparities in CVD morbidity and mortality. Intervening at multiple levels among high-risk groups should be a priority.

The Impact of Sugar-Sweetened Beverage Taxes by Household Income: A Multi-City Comparison of Nielsen Purchasing Data

Due to the role that sugar-sweetened beverages (SSBs) play in the obesity epidemic, SSB taxes have been enacted in the United States in the California cities of Albany, Berkeley, Oakland, and San Francisco, as well as in Boulder, Philadelphia, and Seattle. We pooled five years of Nielsen Consumer Panel and Retail Scanner Data (2014-18) to examine purchasing behaviors in and around these cities that have instituted SSB taxes. We included households that were either subject to the tax during the study period or were in surrounding areas within the same state. The goal was to test for the differential impact of SSB taxes by income level and type of tax. Multivariate analyses of beverage purchases found that (1) there is a dose-response relationship with the size of the SSB tax; (2) the Philadelphia tax, which is the only one that includes low-calorie beverages, is associated with greater reductions in SSB purchases and an increase in bottled water purchase; and (3) approximately 72% of the tax is passed through to consumers, but this does not vary by income level of the household. Few income-related effects were detected. Overall, our findings suggest that the Philadelphia model may be the most effective at encouraging healthy habits in beverage choice.