Skip to main content

Evaluating the Health Impacts of Food and Beverage Taxes

Abstract

Several jurisdictions are now imposing taxes on food and beverages to prevent obesity (and related conditions). Existing evidence concerning their effects comes largely from simulation studies and trials in closed settings, both of which have limitations. Rigorous evaluation of actual taxes may provide richer evidence with greater external validity to support policy making. This article describes existing evaluation studies and outlines an implicit underlying theoretical framework for how taxes are expected to affect health. It then explores three important issues for future studies: selection of an appropriate evaluative perspective (comparing realist and biomedical experimental paradigms); approaches to causal inference; and the challenge of a low signal-to-noise ratio. We argue that evaluation should be informed by a realist perspective as well as making appropriate use of established empirical quasi-experimental approaches to testing causal effects. This should be underpinned by a theoretical framework that acknowledges complexity and the potential diversity of impacts.

This is a preview of subscription content, access via your institution.

Fig. 1

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Mytton OT, Clarke D, Rayner M. Taxing unhealthy food and drinks to improve health. BMJ Br Med J. 2012;2931(May):1–7.

    Google Scholar 

  2. 2.

    Brownell KD, Frieden TR. Ounces of prevention–the public policy case for taxes on sugared beverages. N Engl J Med. 2009;360:1805–8.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Academy of Medical Royal Colleges. Measuring up: the medical professions’s prescription for the nation's obesity crisis. London; 2013.

  4. 4.

    Shemilt I, Hollands GJ, Marteau TM, Nakamura R, Jebb SA, Kelly MP, et al. Economic instruments for population diet and physical activity behaviour change: a systematic scoping review. PLoS One. 2013;8:e75070.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  5. 5.

    Powell LM, Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obes Rev. 2013;14:110–28.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  6. 6.

    Eyles H, Ni Mhurchu C, Nghiem N, Blakely T. Food pricing strategies, population diets, and non-communicable disease: a systematic review of simulation studies. PLoS Med. 2012;9:e1001353.

    PubMed Central  PubMed  Article  Google Scholar 

  7. 7.

    Mytton O, Gray A, Rayner M, Rutter H. Could targeted food taxes improve health? J Epidemiol Community Health. 2007;61:689–94.

    PubMed Central  PubMed  Article  Google Scholar 

  8. 8.

    Shemilt I, Marteau TM, Smith RD, Ogilvie D. Biting off more than we can chew? Limitations in the use of modelling to inform policy on food tax and subsidy. Press.

  9. 9.

    Mytton O, Clarke D, Rayner M, Mytton OT. Taxes on unhealthy food and drinks. 2012;2931(May):1–7.

  10. 10.

    Smed S, Robertson A. Are taxes on fatty foods having their desired effects on health? BMJ. 2012;345:e6885.

    PubMed  Article  Google Scholar 

  11. 11.

    Boseley S. Mexico enacts soda tax in effort to combat world’s highest obesity rate. Theguardian.com. 2014.

  12. 12.

    Pipe S. St Helena shows UK the way with fizzy drinks tax. St Helena Online 2014. http://sthelenaonline.org/2014/03/28/st–helena–sho.

  13. 13.

    Sustain. A children’ s future fund. London; 2012.

  14. 14.

    FIZZ - Fighting sugar in softdrinks. http://www.fizz.org.nz/.

  15. 15.

    Brunner J. Mayor McGinn suggest soft-drink tax for parks money. The Seattle Times. 2013.

  16. 16.

    Kearney L. California city tests waters for soft drinks tax. Reuters. 2014.

  17. 17.

    Beesley A. Reilly sought 20 % tax on sugary drinks in Budget, records who. The Irish Times. 2014.

  18. 18.

    Chriqui JF, Chaloupka FJ, Powell LM, Eidson SS. A typology of beverage taxation: multiple approaches for obesity prevention and obesity prevention-related revenue generation. J Public Health Policy. 2013;34:403–23.

    PubMed Central  PubMed  Article  Google Scholar 

  19. 19.

    Stafford N. Denmark cancels “fat tax” and shelves “sugar tax” because of threat of job losses. BMJ. 2012;345:e7889.

    PubMed  Article  Google Scholar 

  20. 20.

    Consultation on standardised packaging of tobacco products. https://www.gov.uk/government/news/consultation-on-standardised-packaging-of-tobacco-products.

  21. 21.

    Pawson R, Tilley N. Realistic evaluation. London: Sage; 1997.

    Google Scholar 

  22. 22.

    Ogilvie D, Bull F, Powell J, Cooper AR, Brand C, Mutrie N, et al. An applied ecological framework for evaluating infrastructure to promote walking and cycling: the iConnect study. Am J Public Health. 2011;101:473–81.

    PubMed Central  PubMed  Article  Google Scholar 

  23. 23.

    Ogilvie D, Cummins S, Petticrew M, White M, Jones A, Wheeler K. Assessing the evaluability of complex public health interventions: five questions for researchers, funders, and policymakers. Milbank Q. 2011;89:206–25.

    PubMed Central  PubMed  Article  Google Scholar 

  24. 24.

    Bahl R. The uneasy case against discriminatory excise taxation: soft drink taxes in Ireland. Public Financ Rev. 2003;31. doi:10.1177/1091142103253753.

  25. 25.

    Taxable food. http://www.ato.gov.au/Business/GST/In-detail/Your-industry/Food/GST-food-guide/?page=3%23Taxable_food.

  26. 26.

    Faculty of Public Health. A duty on sugar sweetened beverages. London; 2013.

  27. 27.

    Landon J, Graff H. What is the role of health-related food duties? London; 2012.

  28. 28.

    Powell LM, Chriqui J, Chaloupka FJ. Associations between state-level soda taxes and adolescent body mass index. J Adolesc Health. 2009;45(3 Suppl):S57–63.

    PubMed  Article  Google Scholar 

  29. 29.

    Thow AM, Quested C, Juventin L, Kun R, Khana N, Swinburn B. Taxing soft drinks in the Pacific: implementation lessons for improving health. Health Promot Int. 2011;26:55–64.

    PubMed  Article  Google Scholar 

  30. 30.

    Ball K, Timperio AF, Crawford DA. Understanding environmental influences on nutrition and physical activity behaviors: where should we look and what should we count? Int J Behav Nutr Phys Act. 2006;3:33.

    PubMed Central  PubMed  Article  Google Scholar 

  31. 31.

    Smed S, Jensen JD, Denver S. Socio-economic characteristics and the effect of taxation as a health policy instrument. Food Policy. 2007;32:624–39.

    Article  Google Scholar 

  32. 32.

    Briggs ADM, Mytton OT, Kehlbacher A, Tiffin R, Rayner M, Scarborough P. Overall and income specific effect on prevalence of overweight and obesity of 20 % sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study. BMJ. 2013;347:f6189.

    PubMed Central  PubMed  Article  Google Scholar 

  33. 33.

    Finkelstein EA, Zhen C, Nonnemaker J, Todd JE. Impact of targeted beverage taxes on higher- and lower-income households. Arch Intern Med. 2010;170:2028–34.

    PubMed  Article  Google Scholar 

  34. 34.•

    Petticrew M, Anderson L, Elder R, Grimshaw J, Hopkins D, Hahn R, et al. Complex interventions and their implications for systematic reviews: a pragmatic approach. J Clin Epidemiol. 2013;66:1209–14. A discussion fo complexity within public health interventions and its implications for evaluation of interventions, with a particular focus on how to piece together information from different studies in diffferent contexts.

    PubMed  Article  Google Scholar 

  35. 35.

    Kim D, Kawachi I. Food taxation and pricing strategies to “thin out” the obesity epidemic. Am J Prev Med. 2006;30:430–7.

    PubMed  Article  Google Scholar 

  36. 36.•

    Jensen JD, Smed S. The Danish tax on saturated fat – Short run effects on consumption, substitution patterns and consumer prices of fats. Food Policy. 2013;42:18–31. An example of an evaulation of an actual tax on food with the use of robust statistical techniques and consideration of appropriate confounding influences.

    Article  Google Scholar 

  37. 37.

    Berardi N, Sevestere P, Tepaut M, Vigneron A. The impact of a “soda Tax” on prices: evidence from French micro data. Paris; 2012.

  38. 38.

    Sturm R, Powell LM, Chriqui JF, Chaloupka FJ. Soda taxes, soft drink consumption, and children’s body mass index. Health Aff (Millwood). 2010;29:1052–8.

    Article  Google Scholar 

  39. 39.

    Victora CG, Habicht J-P, Bryce J. Evidence-based public health: moving beyond randomized trials. Am J Public Health. 2004;94:400–5.

    PubMed Central  PubMed  Article  Google Scholar 

  40. 40.

    Datta J, Petticrew M. Challenges to evaluating complex interventions: a content analysis of published papers. BMC Public Health. 2013;13:568.

    PubMed Central  PubMed  Article  Google Scholar 

  41. 41.

    Finegood DT, Merth TDN, Rutter H. Implications of the foresight obesity system map for solutions to childhood obesity. Obesity (Silver Spring). 2010;18 Suppl 1:S13–6.

    Article  Google Scholar 

  42. 42.

    Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, et al. Foresight Tackling Obesities: Future Choices. London; 2007.

  43. 43.

    Rutter H. Where next for obesity? Lancet. 2011;378:746–7.

    PubMed  Article  Google Scholar 

  44. 44.

    Craig P, Cooper C, Gunnell D, Haw S, Lawson K, Macintyre S, et al. Using natural experiments to evaluate population health interventions: guidance for producers and users of evidence. London: MRC; 2011.

    Google Scholar 

  45. 45.

    Humphreys DK, Panter J, Sahlqvist S, Goodman A, Ogilvie D. A framework for considering exposure in place-based natural experimental studies in public health. Press.

  46. 46.

    Edwards P, Steinbach R, Green J, Petticrew M, Goodman A, Jones A, et al. Health impacts of free bus travel for young people: evaluation of a natural experiment in London. J Epidemiol Community Health. 2013;67:641–7.

    PubMed  Article  Google Scholar 

  47. 47.

    Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100:216–22.

    PubMed Central  PubMed  Article  Google Scholar 

  48. 48.

    Howel D. Trends in the prevalence of obesity and overweight in English adults by age and birth cohort, 1991-2006. Public Health Nutr. 2011;14:27–33.

    PubMed  Article  Google Scholar 

  49. 49.

    Lin B-H, Smith TA, Lee J-Y, Hall KD. Measuring weight outcomes for obesity intervention strategies: the case of a sugar-sweetened beverage tax. Econ Hum Biol. 2011;9:329–41.

    PubMed  Article  Google Scholar 

  50. 50.

    Bland JM, Altman DG. Statistics notes: multiple significance tests: the Bonferroni method. BMJ. 1995;310:170.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

Download references

Acknowledgements

We acknowledge Ian Shelmit for his constructive comments on our thinking in this area.

Compliance with Ethics Guidelines

Conflict of Interest

Helen Eyles received grants from Heart Foundation of New Zealand and Health Research Council of New Zealand.

Oliver T Mytton and David Ogilvie declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Oliver T. Mytton.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mytton, O.T., Eyles, H. & Ogilvie, D. Evaluating the Health Impacts of Food and Beverage Taxes. Curr Obes Rep 3, 432–439 (2014). https://doi.org/10.1007/s13679-014-0123-x

Download citation

Keywords

  • Food
  • Beverages
  • Tax
  • Evaluation
  • Obesity