BackgroundIn October 2014, Chile implemented a tax modification on sugar-sweetened beverages (SSBs) called the Impuesto Adicional a las Bebidas Analcohólicas (IABA). The design of the tax was unique, increasing the tax on soft drinks above 6.25 grams of added sugar per 100 mL and decreasing the tax for those below this threshold.Methods and findingsThis study evaluates Chile’s SSB tax, which was announced in March 2014 and implemented in October 2014. We used household-level grocery-purchasing data from 2011 to 2015 for 2,836 households living in cities representative of the urban population of Chile. We employed a fixed-effects econometric approach and estimated the before–after change in purchasing of SSBs controlling for seasonality, general time trend, temperature, and economic fluctuations as well as time-invariant household characteristics. Results showed significant changes in purchasing for the statistically preferred model: while there was a barely significant decrease in the volume of all soft drinks, there was a highly significant decrease in the monthly purchased volume of the higher-taxed, sugary soft drinks by 21.6%. The direction of this reduction was robust to different empirical modelling approaches, but the statistical significance and the magnitude of the changes varied considerably. The reduction in soft drink purchasing was most evident amongst higher socioeconomic groups and higher pretax purchasers of sugary soft drinks. There was no systematic, robust pattern in the estimates by household obesity status. After tax implementation, the purchase prices of soft drinks decreased for the items for which the tax rate was reduced, but they remained unchanged for sugary items, for which the tax was increased. However, the purchase prices increased for sugary soft drinks at the time of the policy announcement. The main limitations include a lack of a randomised design, limiting the extent of causal inference possible, and the focus on purchasing data rather than consumption or health outcomes.ConclusionsThe results of subgroup analyses suggest that the policy may have been partially effective, though not necessarily in ways that are likely to reduce socioeconomic inequalities in diet-related health. It remains unclear whether the policy has had a major, overall population-level impact. Additionally, because the present study examined purchasing of soft drinks for only 1 year, a longer-term evaluation—ideally including an assessment of consumption and health impacts—should be conducted in future research.Trial registrationClinicalTrials.gov Identifier: NCT02926001

Objectives. To report the surveillance of COVID-19 pandemic in Chile and analyse the response to public health interventions implemented from 3 March to 30 June 2020 and to assess the risks of collapse of the health care system. Methods. We analysed the effective reproductive number, underreporting of cases, burden of critical beds, case fatality ratio and number of diagnostic RT-PCR for SARS-CoV-2. Results. After an accelerated onset, the COVID-19 pandemic seemed to be relatively controlled in Chile (late April 2020), with reproductive numbers close to 1.00. However, at this time, the load of infected patients was high, with an important number of underreported cases; the diagnostic effort was still limited and heterogeneous across regions. After 1 May up to 30 June a marked exponential increase in the number of cases was observed with a peak on June 14. In this last period the occupation of intensive care unit beds increased to saturation level (89% nationally; 95% in the Metropolitan Region). Conclusions. Our findings suggest that the implemented public health interventions have been initially effective in decreasing the spread of the pandemic. Premature decisions to relax these interventions may have resulted in a rebound in cases with a rapid saturation of the health care system.

The Coronavirus disease 2019 (COVID-19) pandemic is challenging societies, governments and economies at an unprecedented scale. Policy responses to face the epidemic virus had varied greatly among countries, from massive testing, large scale lockdowns to more voluntary approaches for social distancing. The analysis of such policies has been framed mainly with the sole aim of reducing virus transmission (“Flatten the curve” strategies), such as suppression and mitigation approaches. In this article, we argue that the overarching goal of the policy response should not be reducing the viral spread but to ultimately reduce the negative impacts on health and wellbeing of the COVID-19 pandemic. This requires not only interventions to reduce virus transmission, but also policies aimed at increasing the capacity of the health system’s response (“Raising the line” strategies), mitigating the negative consequences of the epidemic and potential adverse effects of interventions to tackle the outbreak (Mitigation strategies) and increasing governmental capacities to respond to the crisis (Strengthening Governance strategies). We propose PoliMap, a comprehensive taxonomy addressing these four policy domains. We present an overview of potential policies in each domain and discuss cross-cutting dimensions of policy responses as the dynamic nature of policymaking, alignment of policy responses at different levels, types of policy instruments, coverage of interventions and gendered-impact of policies. This taxonomy could be used to systematically map, monitor and compare policy responses across countries and over time, in conjunction with morbidity, mortality and demographic data, used to obtain a broad view of the societal effects of COVID-19 pandemic.

In the context of the COVID‐19 pandemic, personal protective measures (e.g., social distancing, handwashing, and mask wearing) have been adopted as a cornerstone to limit the spread of the disease. Yet, the effectiveness of these measures depends on people's levels of adherence. In this article, we apply social‐psychological research to the study of compliance with personal protective measures during the COVID‐19 pandemic in Chile. We consider three possible models underlying adherence: (1) sociodemographic and socioeconomic factors, (2) instrumental factors, and (3) normative factors. We draw on data from a longitudinal nonrepresentative panel study (Study 1, n = 32,304) and a cross‐sectional representative survey (Study 2, n = 1,078) to explore the impact of these different factors on personal protective measures compliance. Findings show the strongest support for the role of instrumental and normative factors, in that people who comply with protective measures report to a greater extent that relatives and friends comply too and tend to perceive high risk of COVID‐19. We finish by proposing policy recommendations to promote effective strategies to contain the spread of the virus.

Background Countries confronting the COVID-19 pandemic are implementing different social distancing strategies. We evaluated the impact of small-area lockdowns in Chile, aimed to reduce viral transmission while minimizing the population disrupted. The effectiveness of this intervention on the outbreak control is unknown. Methods A natural experiment assessing the impact of small-area lockdowns between February 15th and April 25th, 2020. We used mobility data and official governmental reports to compare regions with small-area lockdowns versus regions without. The primary outcome was the mean difference in the effective reproductive number (Re) of COVID-19. Secondary outcomes were changes in mobility indicators. We used quasi-experimental methods for the analysis and examined the impact of other concurrent public health interventions to disentangle their effects. Results Small-area lockdown produced a sizable reduction in human mobility, equivalent to an 11.4% reduction (95%CI -14.4% to -8.38%) in public transport and similar effects in other mobility indicators. Ten days after implementation, the small-area lockdown produced a reduction of the effective reproductive number (Re) of 0.86 (95%CI -1.70 to -0.02). School and university closures, implemented earlier, led to a 40% reduction in urban mobility. Closure of educational institutions resulted in an even greater Re reduction compared with small-area lockdowns. Conclusions Small-area lockdowns produced a reduction in mobility and viral transmission, but the effects were smaller than the early closures of schools and universities. Small-area lockdowns may have a relevant supporting role in reducing SARS-CoV-2 transmission and could be useful for countries considering scaling-down stricter social distancing interventions.

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This article examines the policy change process that resulted in the current sugar-sweetened beverages taxes in Mexico and Chile, using the Kaleidoscope Model for Policy Change, a framework developed for nutrition and food policy change analysis. We used a qualitative study design, including 24 key informant (KI) interviews (16 researchers, 5 civil society representatives and 3 food/beverage industry representatives), encompassing global and in-country perspectives. The analysis shows concurrence with the Kaleidoscope Model, highlighting commonalities in the policy change process. These included the importance of focusing events and coalitions for agenda-setting. Both top-down executive leadership and bottom-up pressure from civil society coalitions were important for the policy adoption as were flexible framing of the tax, and taking advantage of windows of opportunity. In both countries, the tax resulted from national, revenue-seeking fiscal reforms and in sub-optimal tax rates, as a result of the industry influence. KIs also discussed emerging evaluation results, highlighting differences in interpretation concerning the magnitude of change from the tax, and shared potential modifications to the current policies. This analysis contributes to a greater understanding of the policy change process focused on obesity prevention, using an innovative theoretical framework developed specifically for food and nutrition policy.

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