The effect of fiscal policy on diet, obesity and chronic disease: a systematic review
Anne Marie Thow, Stephen Jan, Stephen Leeder & Boyd Swinburn
Volume 88, Number 8, August 2010, 609-614
Table 1. Studies on the effects of fiscal policy on food consumption included in systematic literature review
| Study and year | Study focus | Study typea and country | Data | Taxation change | Effect on target | Other effects | |
|---|---|---|---|---|---|---|---|
| Peer-reviewed studies | |||||||
| Outcome assessed: consumption | |||||||
| Bahl et al. 2003 |
Soft drink demand | Empirical–ecological, Ireland | Sales data | Excise tax on soft drinks decreased from IR£ 0.37/gallon to IR£ 0.29/gallon | Consumption increase was 6.8%. If whole tax reduction had been passed on, increase would have been 15% | Revenue loss approximately IR£ 2 million/year | |
| Jensen & Smed 2007 |
Food and nutrient consumption | Modelling, Denmark | Aggregate consumption | VAT on fruit and vegetables halved. The following taxes and subsidies were scaled to be equivalent to this reduction: fibre subsidy; taxes on fat, saturated fat and sugar; and revenue-neutral combination | Small changes in targeted nutrient and food consumption. Best scenario: revenue-neutral subsidy on fibre and tax on saturated fats and sugar. Sugar consumption decreased 6.5%, fat consumption decreased 2.5%, saturated fat consumption decreased 3.6%, and fibre consumption increased 6.5% | None noted | |
| Santarossa & Mainland 2003 |
Nutrient consumption | Modelling, Scotland | Household consumption | Tax rates needed to change nutrient consumption to meet recommendations; taxes increased the price of meat by 1%, of dairy products by 4%, of eggs by 11%, and of fats and oils by 24% | Energy consumption decreased 17.5%; fat consumption decreased 20% | None noted | |
| Smed et al. 2007 |
Food and nutrient consumption | Modelling, Denmark | Household purchases | Price of meat, butter and fat increased by 5%; VAT on fruit and vegetables halved. The following modelling scenarios were all scaled to have an equivalent effect on consumers as the above VAT reduction: fibre subsidy; taxes on fat, saturated fat and sugar; and revenue-neutral combinations | More effective to target nutrients than foods. Best scenario: saturated fat and sugar tax plus fibre subsidy resulted in a sugar consumption decrease of 16%, saturated fat consumption decrease of 8%, and increased fibre consumption of 15% | Younger consumers and lower income groups responded more, especially in saturated fat consumption | |
| Outcome assessed: consumption and body weight | |||||||
| Chouinard et al. 2007 |
Dairy product demand | Modelling, USA | Household purchases | 10% and 50% tax on dairy products by fat content | Daily fat intake decreased by 2–3 g with 50% tax; no noticeable effect on weight | Highly regressive | |
| Kuchler et al. 2004, |
Snack food consumption and body weight | Modelling, USA | Household purchases | Salty snack food excise taxes: 1 US cent/pound weight (i.e. 0.4%), 1% and 20% | 1 US cent/pound weight and 1% tax had no effect on consumption or body weight; 20% tax decreased body weight by 115–170 g/person per year, equivalent to a reduction in energy intake of around 830 calories. | 1 US cent/pound weight gave US$ 40 million revenue; 1% tax gave US$ 100 million; 20% gave US$ 500–700 million | |
| Outcome assessed: consumption and disease | |||||||
| Cash et al. 2005 |
Fruit and vegetable demand and heart disease risk | Modelling, USA | Individual consumption | Subsidy to decrease fruit and vegetable prices by 1% | Prevented 6733 cases of coronary heart disease and 2946 cases of ischaemic stroke | Average cost per life saved was US$ 1.29 million | |
| Marshall 2000 |
Saturated fat consumption and heart disease risk | Modelling, United Kingdom | Individual consumption | Extend 17.5% VAT to main sources of saturated fat | Decreased ischaemic heart disease by 1.8–2.6%, equivalent to 1800–2500 deaths/year, with 900–1000 deaths/year in people under 75 years | None noted | |
| Mytton et al. 2007 |
Nutrient consumption and heart disease risk | Modelling, United Kingdom | Individual consumption | Extend 17.5% VAT to: (i) sources of saturated fat, and (ii) unhealthy foods; (iii) modification of the above for the best health outcome | (i) increased CVD deaths due to increased salt intake; (ii) decreased CVD deaths by 1.2%; (iii) decreased CVD deaths by 1.7% | Best scenario increased food expenditure by 4.6%. | |
| Nnoaham et al. 2009 |
Nutrient consumption and CVD and cancer mortality | Modelling, United Kingdom | Individual consumption | Extend 17.5% VAT to: (i) sources of saturated fat; (ii) unhealthy foods (nutrient profiling); (iii) unhealthy foods, with 17.5% fruit and vegetable subsidy; (iv) unhealthy foods, with all tax revenue going to a fruit and vegetable subsidy | (i) no mortality reduction; (ii) CVD and cancer deaths increased by 35–1300 per year; (iii) up to 2900 CVD and cancer deaths averted per year; (iv) up to 6400 CVD and cancer deaths averted per year | All policies would be economically regressive and positive health effects would not necessarily be greater in lower income groups | |
| Outcome assessed: body weight | |||||||
| Asfaw 2007 |
Subsidized food and mothers’ BMI | Empirical–ecological, Egypt | Household consumption | Food subsidy programme: 57% for bread; 42–62% for sugar | 1% price increase in bread decreased BMI by 0.12%; 1% price increase in sugar decreased BMI by 0.11%; 1% price decrease in fruit and vegetables decreased BMI by 0.09%; 1% price decrease in eggs and milk decreased BMI by 0.14% | Cost US$ 1.1 billion in 1997 values | |
| Kim & Kawachi 2006 |
State taxes and obesity | Empirical–ecological, USA | Obesity prevalence | State taxes on soft drinks or snack foods | No association with obesity point prevalence; states with no tax were more than 4 times as likely to experience a high relative increase in obesity prevalence; those that repealed a tax were more than 13 times as likely | None noted | |
| Schroeter et al. 2008 |
Body weight | Modelling, USA | Individual consumption | 10% tax or subsidy: (i) tax on food away from home; (ii) tax on soft drinks; (iii) subsidy for fruit and vegetables; (iv) subsidy for diet soft drinks | Daily weight change: (i) 0.196% increase; (ii) 0.099% (0.086 kg) decrease in men and 0.122% (0.091 kg) decrease in women; (iii) 0.222% increase: 0.193 kg in men and 0.166 kg in women; (iv) 0.071% decrease | None noted | |
| Grey literature | |||||||
| Outcome assessed: consumption | |||||||
| Dong & Lin 2009 |
Fruit and vegetable demand | Modelling, USA | Household purchase | 10% subsidy for fruit and vegetables for people on low incomes | Household fruit consumption increased by 2.1–5.2% and vegetable consumption, by 2.1–4.9% | Cost: US$ 308 million for fruit subsidy, US$ 274 million for vegetable subsidy | |
| Gabe 2008 |
Soft drink consumption and economy | Modelling, USA | Sales data | Excise tax: US$ 0.42/gallon of bottled drinks and US$ 4.00/gallon of soft drink syrup; equivalent to around a 10% tax | Soft drink sales volume decreased by 4.8% and sports drink volume decreased by 3.2% | Revenue: US$ 31.4 million; jobs lost with decreased production | |
| Gustavsen 2005 |
Soft drink consumption | Modelling, Norway | Household purchases | Doubling of production tax and VAT on soft drinks; price increased by 27% | Top 5% of soft drink consumers decreased consumption by around 44%, or 74 l/year; lowest soft drink consumers decreased consumption by 17%, or 2 l/year | None noted | |
| Nordström & Thunström 2007 |
Nutrient consumption | Modelling, Sweden | Household purchases | Removal of VAT plus subsidy for healthy grain products | 50% subsidy required to increased fibre intake to recommended level; 114% tax on bakery and ready-to-eat products could fund this subsidy | Increased fat, salt and sugar intake | |
| Tefft 2008 |
Soft drink expenditure | Empirical–ecological, USA | Household purchases | State soft drink tax | Soft drink tax increase of 10% decreased probability of soft drink expenditure by 0.7% | None noted | |
| Outcome assessed: consumption and body weight | |||||||
| Allais et al. 2008 |
Complete food demand system | Modelling, France | Household purchases | 10% VAT increase for cheese and butter products, sugar and fat products, and ready-made meals | All tax rises decreased total energy and saturated fat intake; taxing both sugar and fat products and cheese and butter products increased polyunsaturated fat use; taxing all three food groups gave weight decrease of 1.3 kg/year | Ready-made meal tax increased fat-soluble vitamin intake and decreased sodium, vitamin B and good fat intake; government revenue increased by 16% | |
| Fantuzzi 2008 |
Soft drink consumption and body weight | Modelling, USA | Household purchases | 20% ad valorem tax and 10 US cent/calorie tax on soft drinks | Insignificant impact: e.g. for Pepsi, 20% tax decreased energy intake by 4 258 calories/year and body weight by 1.22 lb/year; 10 US cent/calorie tax decreased energy intake by 3002 calories/year and body weight by 0.89 lb/year | 10 US cent/calorie tax would result in US$ 9 tax on an average can of soft drink containing 90 calories | |
| Farra et al. 2005 |
Soft drink consumption and body weight | Modelling, USA | Obesity prevalence | 10% excise tax on sugared soft drinks | Per capita consumption decreased by 23 l (6 gallons)/year, equivalent to a weight loss of 1.4 kg (3 lb); 4% decrease in obesity prevalence | Regressive tax | |
| Outcome assessed: consumption and disease | |||||||
| No studies found. | |||||||
| Outcome assessed: body weight | |||||||
| Fletcher et al. 2008 |
State taxes and obesity | Empirical–ecological, USA | Population BMI data from the BRFSS | State soft drink taxes; average 3% | 1% tax increase decreased BMI by 0.003 points | Largest impacts in low and high income earners at the tails of the distribution and in Hispanic –Americans | |
| Gelbach et al. 2007 |
Food consumption and body weight | Modelling, USA | Individual BMI, price data | 100% tax on unhealthy foods | Decreased average BMI by around 1% and decreased incidence of overweight by 2% and obesity by 1% | Very small differences in price sensitivity with education, race and gender | |
| Oaks 2005 |
State snack tax and obesity | Empirical–ecological, USA | Obesity prevalence data from the BRFSS | State tax of 5.5% on soft drinks and snacks | No relationship between obesity and state tax | None noted | |
BMI, body mass index; BRFSS, Behavioural Risk Factor Surveillance Survey; CVD, cardiovascular disease; IR£, Irish pounds; USA, United States of America; VAT, value added tax.
a Empirical–ecological studies are based on observed outcomes; modelling studies are based on predicted outcomes.