What are the outcomes of implemented sugar-sweetened beverage (SSB) taxes around the world?
In this systematic review of 86 studies and a meta-analysis of 62 studies, implemented SSB taxes were associated with higher prices of targeted beverages (tax pass-through of 82%) and 15% lower SSB sales, with a price elasticity of demand of -1.59. No negative changes in employment were identified.
These findings suggest that SSB taxes may work as intended in reducing demand for SSBs through higher prices, yet further research is needed to understand their associations with diet and health outcomes and heterogeneity of consumer responses.
More than 45 countries and several local jurisdictions have implemented sugar sweetened beverage (SSB) taxes to improve nutrition and population health, and evidence on their
outcomes to date is essential to inform policy discussions. Responding to this need, the World Health Organization commissioned a systematic literature review on the outcomes of fiscal policies, including SSB taxes.
To assess the associations of implemented SSB taxes with prices, sales, consumption, diet, body weight, product changes, unintended consequences, health, and pregnancy outcomes.
DATA SOURCES Searches of 8 bibliographic databases (Business Source Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EconLit, PsycINFO, PubMed, and Scopus) were performed from database inception through June 1, 2020, with no language or setting restrictions. Grey literature was assessed using 14 sources and government websites.
STUDY SELECTION The review included primary studies of implemented SSB taxes.
DATA EXTRACTION AND SYNTHESIS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. For prices, sales and consumption, results were meta-analyzed using a 3-level random-effects model. Study quality was assessed at the outcome level.
MAIN OUTCOMES AND MEASURES
Tax pass-through rate for prices, percentage reduction in SSB demand, and price elasticity of demand for sales and consumption. Heterogeneity was assessed using ?2 and the I2 statistic.
A total of 86 articles were eligible, with 62 studies contributing to the meta-analysis. The overall tax pass-through rate was 82%(95%CI, 66%to 98%; P < .001, I2 = 99%), suggesting tax undershifting. The demand for SSBs was highly sensitive to tax-induced price increases, with the price elasticity of demand of ?1.59 (95%CI, ?2.11 to ?1.08; P < .001; I2 = 100%) and a mean reduction in SSB sales of 15%(95%CI, ?20% to ?9%; P < .001; I2 = 100%). There was no evidence of substitution to untaxed beverages, and changes in SSB consumption were not significant. The narrative synthesis found reformulation and reduced sugar content of taxed beverages for tiered taxes, cross-border shopping in most studies of local-level taxes, and no negative changes in employment. Data on the heterogeneity of SSB tax outcomes across subpopulations were limited.
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis of implemented SSB taxes worldwide, SSB taxes were associated with higher prices and lower sales of taxed beverages.
Sugar-sweetened beverage (SSB) taxes are proposed as a policy tool to address the increasing prevalence of poor diet, obesity, and related economic and social costs.1,2 Noncommunicable diseases (NCDs) account for 71% of deaths globally, of which an estimated 40% could be attributed to dietary factors.3,4 Recently, concerns about diet-related NCDs grew further because of their association with more severe clinical outcomes from COVID-19, including hospitalization and death.5,6 There are well-documented negative health consequences of excessive SSB consumption in children and adults, including weight gain and increased risk of type 2 diabetes, cardiovascular disease, dental caries, and osteoporosis.7-9
To improve nutrition and health and to raise revenue, various types of SSB taxes have been implemented in more than 45 countries, including numerous subnational local jurisdictions.10 Evidence on their effects is growing as multiple evaluations are undertaken to provide policy makers with comprehensive real-time data. Prior systematic reviews11-17 suggested that price interventions and fiscal policies targeting SSBs and other unhealthy products could influence consumer choices and reduce demand. Much of this earlier literature was based on price data and simulation studies owing to the lack of real-world SSB taxes at the time.10 There is now a critical need for the synthesis of literature on the outcomes of recently implemented SSB taxes to inform decision-making about the use of fiscal policy to create incentives for improving diet and health.
This study offers a systematic review and meta-analysis of the literature on implemented SSB taxes to provide comprehensive guidance on the outcomes associated with SSB taxation worldwide. It is part of a broader systematic review on the outcomes of fiscal and pricing policies on foods and nonalcoholic beverages commissioned by the World Health Organization (WHO). The review is intended to inform guidelines that will support WHO Member States in developing and implementing fiscal and pricing policies to promote healthy diets. This review is also expected to be of interest to policy makers in subnational jurisdictions and expand our understanding of effective policy approaches to improving public health…
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