The potential impact of food taxes and subsidies on cardiovascular disease and diabetes burden and disparities in the United States

Abstract

BackgroundFiscal interventions are promising strategies to improve diets, reduce cardiovascular disease and diabetes (cardiometabolic diseases; CMD), and address health disparities. The aim of this study is to estimate the impact of specific dietary taxes and subsidies on CMD deaths and disparities in the US.MethodsUsing nationally representative data, we used a comparative risk assessment to model the potential effects on total CMD deaths and disparities of price subsidies (10%, 30%) on fruits, vegetables, whole grains, and nuts/seeds and taxes (10%, 30%) on processed meat, unprocessed red meats, and sugar-sweetened beverages. We modeled two gradients of price-responsiveness by education, an indicator of socioeconomic status (SES), based on global price elasticities (18% greater price-responsiveness in low vs. high SES) and recent national experiences with taxes on sugar-sweetened beverages (65% greater price-responsiveness in low vs. high SES).ResultsEach price intervention would reduce CMD deaths. Overall, the largest proportional reductions were seen in stroke, followed by diabetes and coronary heart disease. Jointly altering prices of all seven dietary factors (10% each, with 18% greater price-responsiveness by SES) would prevent 23,174 (95% UI 22,024–24,595) CMD deaths/year, corresponding to 3.1% (95% UI 2.9–3.4) of CMD deaths among Americans with a lower than high school education, 3.6% (95% UI 3.3–3.8) among high school graduates/some college, and 2.9% (95% UI 2.7–3.5) among college graduates. Applying a 30% price change and larger price-responsiveness (65%) in low SES, the corresponding reductions were 10.9% (95% UI 9.2–10.8), 9.8% (95% UI 9.1–10.4), and 6.7% (95% UI 6.2–7.6). The latter scenario would reduce disparities in CMD between Americans with lower than high school versus a college education by 3.5 (95% UI 2.3–4.5) percentage points.ConclusionsModest taxes and subsidies for key dietary factors could meaningfully reduce CMD and improve US disparities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0971-9) contains supplementary material, which is available to authorized users.

Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries

“…For instance, effective community-based strategies (e.g. campaigns, re-formulation, and decreasing taxes) that target improving intakes of whole grains and nuts should be implemented according to these results [21][22][23]. Moreover, our findings support campaigns like the five-a-day initiative [24], or campaigns reducing SSB [25], and sodium reduction strategies like food reformulation (e.g.…”

What to expect from the price of healthy and unhealthy foods over time? The case from Brazil

“…Policies aimed at food prices should encourage the consumption of healthy, unprocessed or minimally processed foods and discourage the consumption of unhealthy ultra-processed foods. The potential impact of strategies to change the food price scenario in relation to deaths from cardiometabolic diseases was recently modelled for the US population (4) . Using nationally representative data, a comparative risk assessment was performed to model the potential effects on cardiometabolic disease deaths and disparities of price subsidies (10 %, 30 %) for fruits, vegetables, whole grains and nuts/seeds and taxes (10 %, 30 %) on processed meat, unprocessed red meats and sugar-sweetened beverages.…”

Associations between Governmental Policies to Improve the Nutritional Quality of Supermarket Purchases and Individual, Retailer, and Community Health Outcomes: An Integrative Review

“…Nineteen studies examined the impact of supermarket fruit and vegetable subsidies, incentives, vouchers, or prescriptions targeted towards low-income households or individuals [ 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. Results from randomized trials and natural experiments consistently demonstrate increases in household fruit and vegetable purchases or adult fruit and vegetable intake when incentives are targeted towards SNAP participants [ 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]; yet, few studies have been conducted with children [ 52 ].…”

“…Intervention effects, however, may not be sustained after the financial incentive ends [ 54 , 57 ]. Although incentive programs in supermarkets would have high start-up costs if implemented nationally, they are expected to be cost-saving in the long-term, largely due to reductions in type 2 diabetes, heart disease, and stroke [ 60 , 61 , 62 , 63 ]. Compared to research on SNAP incentives, there are limited data on produce prescription programs, which, to date, have been most frequently implemented in farmers’ markets or other limited-service food retail settings [ 49 ].…”