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Valizadeh P, Ng SW. Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income. Am J Prev Med 2024:S0749-3797(24)00076-X. [PMID: 38573260 DOI: 10.1016/j.amepre.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
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.
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Affiliation(s)
- Pourya Valizadeh
- Department of Agricultural Economics, Texas A&M University, College Station, Texas
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Thapa K, Rajbhandari-Thapa J, Hanks A, Lee JS, Zhen C. Sugar sweetened beverage restriction or fruit and vegetable purchase incentive in Supplemental Nutrition Assistance Program (SNAP): Participant’s voice and choice behavior. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2023. [DOI: 10.1080/19320248.2023.2179448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Kiran Thapa
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
| | | | - Andrew Hanks
- Department of Human Sciences, Ohio State University, Columbus, GA, USA
| | - Jung Sun Lee
- Department of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Chen Zhen
- Department of Agriculture and Applied Economics, University of Georgia, Athens, GA, USA
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Ilicic J, Brennan S, Cullerton K. Additional Marketing Responses to a Tax on Sugar-Sweetened Beverages Comment on "Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019". Int J Health Policy Manag 2022; 12:7638. [PMID: 37579488 PMCID: PMC10125102 DOI: 10.34172/ijhpm.2022.7638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/22/2022] [Indexed: 08/16/2023] Open
Abstract
Marketing responses to sugar-sweetened beverage (SSB) taxes are understudied in the literature. Previous research has been limited to examining price and advertising, in particular promotions responses. Forde et al advocate for a focus on exploring a range of marketing responses to a SSB tax, with an emphasis on the marketing mix (price, promotion, product, and place). Their qualitative findings from the United Kingdom focus mostly on possible product and price decisions, with limited discussion of place and promotions decisions. We argue that the proposed marketing mix decisions may be used to avoid or side-step a SSB tax and that their likelihood of adoption may be dependent upon additional factors besides brand strength, reputation, and portfolio size highlighted by Forde and colleagues, such as organizational capabilities, industry competition, and brand positioning. We recommend future research examine the importance of consumer behaviour in developing marketing programs and in response to the marketing mix levers pulled by industry.
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Affiliation(s)
- Jasmina Ilicic
- Monash Business School, Monash University, Caulfield East, VIC, Australia
| | - Stacey Brennan
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
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Ross A, Swart EC, Frank T, Lowery CM, Ng SW. South Africa's Health Promotion Levy on Pricing and Acquisition of Beverages in Local Spazas and Supermarkets. Public Health Nutr 2022; 25:1-26. [PMID: 35249582 PMCID: PMC9991735 DOI: 10.1017/s1368980022000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/03/2022] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In response to concern over rising sugar-sweetened beverage (SSB) consumption, in April 2018, South Africa became the first Sub-Saharan African country to implement an SSB tax. We assess changes in pricing and acquisition of beverages from local supermarkets and small stores among 18-39 year old adults living in one township in the Western Cape, before and after tax implementation. This study is among the first evaluations of an SSB tax on the local food environment in a low-income township. DESIGN Store beverage pricing and participant surveys were cross-sectional, analyzed 1 month before and 11 months after implementation of the tax (March 2018 and March 2019). SETTING Langa, Western Cape, South Africa. PARTICIPANTS Surveyed participants were residents of Langa between 18-39 years old (N=2,693 in 2018 and N=2,520 in 2019). RESULTS Prices of taxed SSBs increased significantly among small shops and supermarkets between 2018 and 2019. There were non-significant decreases in prices of untaxed beverages in small shops, but prices of untaxed beverages increased in supermarkets. Across all store types, there was a 9 percentage point decrease in the probability of purchasing regular soda weekly pre/post-implementation. Reductions in purchasing were larger in small shops than supermarkets. CONCLUSIONS We found some differential impacts of the levy on pricing and acquisition of beverages by retailer type in one low-income township. As other Sub-Saharan African countries consider similar fiscal policies to curb soda consumption, obesity and related diseases, this work can be used to understand the implications of these policies in the retail setting.
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Affiliation(s)
- Alexandra Ross
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa
- DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Tamryn Frank
- School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
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Valizadeh P, Popkin BM, Ng SW. Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor. Am J Clin Nutr 2022; 115:244-255. [PMID: 34610088 PMCID: PMC8755035 DOI: 10.1093/ajcn/nqab330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/27/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed. OBJECTIVES We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and combinations of SSB taxes with fruit and vegetable (FV) subsidies targeted to low-income households on SSB and FV purchases of lower and higher SSB purchasers. METHODS We considered a 1-cent-per-ounce SSB tax and 2 FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan data. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies' differential effects. RESULTS Higher-SSB-purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 compared with 0.5 oz/day at percentile 25; P < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households, regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate. CONCLUSIONS SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels before policy implementation. Expanding taxes beyond SSBs, providing larger FV subsidies, or offering subsidies beyond FVs, particularly for low-income households with children, may be more effective.
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Affiliation(s)
- Pourya Valizadeh
- Agricultural & Food Policy Center, Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
- Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
| | - Barry M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol 2021; 9:462-470. [PMID: 33865500 PMCID: PMC8217149 DOI: 10.1016/s2213-8587(21)00078-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
The global surges in obesity and nutrition-related non-communicable diseases (NCDs) have created a need for decisive new food policy initiatives. A major concern has been the impact of ultra-processed foods (UPFs) and ultra-processed drinks on weight gain and on the risk of several NCDs. These foods, generally high in calories, added sugar, sodium, and unhealthy fats, and poor in fibre, protein, and micronutrients, have extensive negative effects on human health and on the environment (due to their associated carbon emission and water use). There is a growing tendency worldwide, and especially in South America, for food companies to add micronutrients to UPFs to make health claims regarding these products, to which food-regulating authorities refer to fake foods. Although more than 45 countries and smaller subregional or urban entities have created taxes on ultra-processed drinks, such as sugar-sweetened beverages, only a few have adopted taxes on snacks and other UPFs, and none have added major subsidies for truly healthy, fresh or minimally processed food for people from lower socioeconomic backgrounds. Another major focus has been on developing effective package labelling. A smaller number of countries have selected the most impactful warning labels and linked them with other measures to create a mutually reinforcing set of policies; a few other countries have developed effective school food policies. We herein present in-depth results from key countries involved in all these actions and in comprehensive marketing controls, and conclude with our recommendations for the future. This field is quite new; progress to date is substantial, but much more is left to learn.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Simon Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karen J Hofman
- South African Medical Research Council Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Carlos Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth C Swart
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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