Implementing fiscal and pricing policies to promote healthy diets: a review of contextual factors

Overview

Prices and promotions of foods and non-alcoholic beverages within the food environment can incentivize or disincentivize consumers’ food decisions. Currently, however, prices and promotions often encourage selection of foods that undermine healthy diets. To address this challenge, and to support Member States in implementing policy measures, as recommended by the Framework for Action from the 2014 Second International Conference on Nutrition, the World Health Organization (WHO) is in the process of developing evidence-informed policy guidelines on the food environment, including fiscal and pricing policies.

This review on contextual factors to be considered in the implementation of fiscal and pricing policies was prepared as part of the required process for WHO guideline development. When developing a WHO guideline and its recommendations, explicit consideration must be given to decision criteria (i.e. contextual factors) when moving from the evidence on the impact of interventions to recommendations. The factors considered in this review are values, resource implications, equity and human rights, feasibility and acceptability by stakeholder, as well as socio-cultural and environmental acceptability. A total of 301 publications were included in the review, the majority for acceptability (n = 153), feasibility (n = 78) and equity and human rights (n = 70). Most identified evidence related to taxation of sugar-sweetened beverages (SSBs). Most modelling studies found taxes on SSBs or unhealthy foods and subsidies on healthy foods to be cost-effective or cost saving. Subsidies in the included literature had an explicit focus on health equity, as they targeted people of lower socio-economic status. Although taxes are generally considered to be financially regressive, many studies found taxes to be equitable because of their progressive health benefits. Due to great variability in acceptability by stakeholder and in feasibility depending on the fiscal policy and its design, the results underline the importance of considering the local context, including the regulatory and political environment, when implementing such policies. Overall, effective implementation of such policies could contribute to achievement of the right to health, a core WHO value.