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Taxes on Sugar-Sweetened Beverages to Reduce Overweight and Obesity in Middle-Income Countries: A Systematic Review

View Article: PubMed Central - PubMed

ABSTRACT

Background: The consumption of sugar-sweetened beverages (SSBs), which can lead to weight gain, is rising in middle-income countries (MICs). Taxing SSBs may help address this challenge. Systematic reviews focused on high-income countries indicate that taxing SSBs may reduce SSB consumption. Responsiveness to price changes may differ in MICs, where governments are considering the tax. To help inform their policy decisions, this review compiles evidence from MICs, assessing post-tax price increases (objective 1), changes in demand for SSBs and other products, overall and by socio-economic groups (objective 2), and effects on overweight and obesity prevalence (objective 3).

Methods and findings: We conducted a systematic review on the effectiveness of SSB taxation in MICs (1990–2016) and identified nine studies from Brazil, Ecuador, India, Mexico, Peru, and South Africa. Estimates for own-price elasticity ranged from -0.6 to -1.2, and decreases in SSB consumption ranged from 5 to 39 kilojoules per person per day given a 10% increase in SSB prices. The review found that milk is a likely substitute, and foods prepared away from home, snacks, and candy are likely complements to SSBs. A quasi-experimental study and two modeling studies also found a negative relationship between SSB prices and obesity outcomes after accounting for substitution effects. Estimates are consistent despite variation in baseline obesity prevalence and per person per day consumption of SSBs across countries studied.

Conclusions: The review indicates that taxing SSBs will increase the prices of SSBs, especially sugary soda, in markets with few producers. Taxing SSBs will also reduce net energy intake by enough to prevent further growth in obesity prevalence, but not to reduce population weight permanently. Additional research using better survey data and stronger study designs is needed to ascertain the long-term effectiveness of an SSB tax on obesity prevalence in MICs.

No MeSH data available.


Logical Pathway from Taxing SSBs to Public Health Impact.
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pone.0163358.g001: Logical Pathway from Taxing SSBs to Public Health Impact.

Mentions: The logical pathway in Fig 1 illustrates how taxes on SSBs can reduce the prevalence of obesity and overweight if several assumptions hold. The pathway is specific to excise taxes which, unlike sales or value added taxes, increase SSB prices relative to other goods [19] and are recommended by the WHO for tobacco control [20]. The pathway first requires that the tax is not fully absorbed by producers and will thus lead to an increase in consumer prices. Given imperfect market competition, this theory postulates that excise taxes can lead to price increases as large or larger than the tax rate when the taxed good, like SSBs, contains many similar, but not identical, products [21]. Still, the extent to which prices increase relative to the tax rate (the “pass-through rate”) depends on factors such as consumers’ responsiveness to price change, which may vary in different socio-economic settings, and the costs producers face [22].


Taxes on Sugar-Sweetened Beverages to Reduce Overweight and Obesity in Middle-Income Countries: A Systematic Review
Logical Pathway from Taxing SSBs to Public Health Impact.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036809&req=5

pone.0163358.g001: Logical Pathway from Taxing SSBs to Public Health Impact.
Mentions: The logical pathway in Fig 1 illustrates how taxes on SSBs can reduce the prevalence of obesity and overweight if several assumptions hold. The pathway is specific to excise taxes which, unlike sales or value added taxes, increase SSB prices relative to other goods [19] and are recommended by the WHO for tobacco control [20]. The pathway first requires that the tax is not fully absorbed by producers and will thus lead to an increase in consumer prices. Given imperfect market competition, this theory postulates that excise taxes can lead to price increases as large or larger than the tax rate when the taxed good, like SSBs, contains many similar, but not identical, products [21]. Still, the extent to which prices increase relative to the tax rate (the “pass-through rate”) depends on factors such as consumers’ responsiveness to price change, which may vary in different socio-economic settings, and the costs producers face [22].

View Article: PubMed Central - PubMed

ABSTRACT

Background: The consumption of sugar-sweetened beverages (SSBs), which can lead to weight gain, is rising in middle-income countries (MICs). Taxing SSBs may help address this challenge. Systematic reviews focused on high-income countries indicate that taxing SSBs may reduce SSB consumption. Responsiveness to price changes may differ in MICs, where governments are considering the tax. To help inform their policy decisions, this review compiles evidence from MICs, assessing post-tax price increases (objective 1), changes in demand for SSBs and other products, overall and by socio-economic groups (objective 2), and effects on overweight and obesity prevalence (objective 3).

Methods and findings: We conducted a systematic review on the effectiveness of SSB taxation in MICs (1990–2016) and identified nine studies from Brazil, Ecuador, India, Mexico, Peru, and South Africa. Estimates for own-price elasticity ranged from -0.6 to -1.2, and decreases in SSB consumption ranged from 5 to 39 kilojoules per person per day given a 10% increase in SSB prices. The review found that milk is a likely substitute, and foods prepared away from home, snacks, and candy are likely complements to SSBs. A quasi-experimental study and two modeling studies also found a negative relationship between SSB prices and obesity outcomes after accounting for substitution effects. Estimates are consistent despite variation in baseline obesity prevalence and per person per day consumption of SSBs across countries studied.

Conclusions: The review indicates that taxing SSBs will increase the prices of SSBs, especially sugary soda, in markets with few producers. Taxing SSBs will also reduce net energy intake by enough to prevent further growth in obesity prevalence, but not to reduce population weight permanently. Additional research using better survey data and stronger study designs is needed to ascertain the long-term effectiveness of an SSB tax on obesity prevalence in MICs.

No MeSH data available.