Effectiveness and equity of sugar-sweetened beverage taxation

Abstract

Given the global epidemics of obesity, type 2 diabetes, and associated cardiovascular disease, numerous strategies are being discussed and implemented to reduce the risk of excess calorie intake and the adverse metabolic effects of unhealthy sugar consumption.While individuallevel interventions such as educational and behavioral modification strategies have been extensively researched, they remain difficult to effectively implement in large populations.Hence, fiscal and regulatory interventions such as sugar-sweetened beverage (SSB) taxation have been widely discussed.SSB taxation is of particular interest given consistent evidence associating SSB consumption with elevated risk of metabolic and cardiovascular disease and the lack of any known positive value of SSBs for nutrition or human health.Moreover, SSBs can be isolated from other foods easily, there are negative externalities of SSB consumption in terms of excess healthcare and disability costs, and strong evidence exists to indicate that taxation has been an effective means for reducing consumption of other unhealthy products such as tobacco [1][2][3][4].Contributing to the debate on the public health case for taxing SSBs, 2 recent articles in PLOS Medicine [5,6] add to the evidence concerning SSB taxation, which has mostly come from Mexico after the country implemented an approximately 10% tax on SSBs in 2014 [7][8][9][10].The new articles address major questions about the effects of SSB taxation: Are SSB taxes passed through from retailers to consumers, and, if so, are the price increases sufficient to reduce SSB consumption?Does substitution of SSBs by other beverages or foods neutralize the benefits of the tax; and does the tax harm retailers or consumers, particularly consumers of low socioeconomic status (SES)? SSB data from Berkeley, CaliforniaIn the first of the 2 articles, Barry Popkin and colleagues performed a study of prices, sales, consumer spending, and beverage consumption before and after a penny-per-ounce tax on SSBs that was implemented starting in March 2015 in Berkeley, California, United States [5].The authors made an extensive effort to triangulate data from stores, sales databases, and telephone surveys of adults in Berkeley.Importantly, sales data analyses included adjacent comparison cities that did not institute a tax, helping to isolate the effects of the tax from macroeconomic conditions that can affect beverage purchases over time, preexisting trends, regional media campaigns that both favored and opposed the tax, and other social and cultural influences on SSB sales across the region.Popkin and colleagues' results, consistent with a previous report [11], reveal that the SSB tax in Berkeley was generally passed through to consumers; notably, pass-through was substantial at the major chain supermarkets at which most SSBs are purchased but not at small

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