Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study

Abstract

SummaryBackgroundIn March, 2016, the UK Government proposed a tiered levy on sugar-sweetened beverages (SSBs; high tax for drinks with >8 g of sugar per 100 mL, moderate tax for 5–8 g, and no tax for <5 g). We estimate the effect of possible industry responses to the levy on obesity, diabetes, and dental caries.MethodsWe modelled three possible industry responses: reformulation to reduce sugar concentration, an increase of product price, and a change of the market share of high-sugar, mid-sugar, and low-sugar drinks. For each response, we defined a better-case and worse-case health scenario. We developed a comparative risk assessment model to estimate the UK health impact of each scenario on prevalence of obesity and incidence of dental caries and type 2 diabetes. The model combined data for sales and consumption of SSBs, disease incidence and prevalence, price elasticity estimates, and estimates of the association between SSB consumption and disease outcomes. We drew the disease association parameters from a meta-analysis of experimental studies (SSBs and weight change), a meta-analysis of prospective cohort studies (type 2 diabetes), and a prospective cohort study (dental caries).FindingsThe best modelled scenario for health is SSB reformulation, resulting in a reduction of 144 383 (95% uncertainty interval 5102–306 743; 0·9%) of 15 470 813 adults and children with obesity in the UK, 19 094 (6920–32 678; incidence reduction of 31·1 per 100 000 person-years) fewer incident cases of type 2 diabetes per year, and 269 375 (82 211–470 928; incidence reduction of 4·4 per 1000 person-years) fewer decayed, missing, or filled teeth annually. An increase in the price of SSBs in the better-case scenario would result in 81 594 (3588–182 669; 0·5%) fewer adults and children with obesity, 10 861 (3899–18 964; 17·7) fewer incident cases of diabetes per year, and 149 378 (45 231–262 013; 2·4) fewer decayed, missing, or filled teeth annually. Changes to market share to increase the proportion of low-sugar drinks sold in the better-case scenario would result in 91 042 (4289–204 903; 0·6%) fewer adults and children with diabetes, 1528 (4414–21 785; 19·7) fewer incident cases of diabetes per year, and 172 718 (47 919–294 499; 2·8) fewer decayed, missing, or filled teeth annually. The greatest benefit for obesity and oral health would be among individuals aged younger than 18 years, with people aged older than 65 years having the largest absolute decreases in diabetes incidence.InterpretationThe health impact of the soft drinks levy is dependent on its implementation by industry. Uncertainty exists as to how industry will react and about estimation of health outcomes. Health gains could be maximised by substantial product reformulation, with additional benefits possible if the levy is passed on to purchasers through raising of the price of high-sugar and mid-sugar drinks and activities to increase the market share of low-sugar products.FundingNone.

Effects of stress on the development and progression of cardiovascular disease

“…[177][178][179] Modelling studies suggest universal diet interventions, such as the UK 'sugar tax', might also benefit population health. 180 Given the much higher numbers of people with stress in the general population than among individuals with advanced disease, the population-attributable risk (a measure of preventive potential) is broadly similar for heart disease in these groups, at 3-7% for chronic stressors in the general population and approximately 4% for stress triggers in high-risk individuals. 9,48,62,124 This suggests there might be scope for multiple stress intervention strategies, including targeted interventions for people with high overall risk and a general plan for everyone, a public health approach.…”

Who self‐cares wins: an updated perspective on men and self‐care

“…A tax imposing a 20% increase in the price of sugarsweetened beverages would result in major reductions in consumption in the UK, especially in boys and young men. 33 2. Health policies that recognise the needs of men, including national men's health policies.…”

British Nutrition Foundation Annual Lecture 2017 – Diet, obesity and cardiovascular risk

“…Professor Jebb gave examples from her work of modelling studies to examine the likely impacts of a tax on sugars‐sweetened beverages (Briggs et al . ; Quirmbach et al . ) and trials to test the effectiveness of nutritional labels (Crockett et al .…”

“…Developing population level interventions largely requires engagement and action by policymakers but researchers have a role in developing the evidence base for these actions and evaluating their effectiveness. Professor Jebb gave examples from her work of modelling studies to examine the likely impacts of a tax on sugarssweetened beverages (Briggs et al 2017;Quirmbach et al 2018) and trials to test the effectiveness of nutritional labels (Crockett et al 2018). She also described the importance of presenting evidence to policymakers in an appropriate format and the value of skilled knowledge brokers.…”