"Would Taxing Unhealthy Foods Improve Public Health?"
Increasing the cost of cigarettes through tobacco taxes
is one of the most effective ways to decrease the harms of smoking.
Increasing the cost of cigarettes by just 10%
could prevent millions of tobacco-related deaths.
So what about taxing unhealthy food?
In general, public health decision-makers have had three main options:
inform consumers with labeling, nudge people with incentives,
or more heavy handed approaches such as instituting regulations or taxes.
These policy approaches have proven crucial
in reducing tobacco use, alcohol abuse, and deaths from car crashes.
For example, driver education alone,
or by labeling cars with information about crash risk,
didn't help as much as making sure they installed air bags.
Given that heart disease alone kills 10 times more people than injuries on the road,
maybe the current epidemic of nutrition-related disease
requires a similar multifaceted approach.
Even modest dietary improvements
could significantly reduce the burden of chronic disease,
so maybe a national system of subsidies for good foods
and taxes for bad could facilitate more sensible dietary choices.
But would they work?
A systematic review of the available evidence suggests that they do,
decreasing the consumption of unhealthy foods—
the more you tax, the lower consumption drops,
and increasing the consumption of healthy foods—
the more you subsidize foods like fruits and vegetables,
the cheaper you make them, the more may be eaten.
A small price difference succeeded in decreasing our exposure to lead.
What about a tax to decrease our exposure to saturated fat?
Such a tax could potentially save thousands of lives.
But wait a second.
Wouldn't such a tax disproportionally affect the poor?
Yes, they would benefit the most!
It's like cigarette taxes: the poor stand to benefit the most.
That's the classic tobacco industry argument:
cigarette taxes are unfair and regressive, burdening the poor the most,
to which the public health community responded:
cancer is unfair, cancer disproportionately burdens the poor,
so taxes would affect the greatest health gains for the least well-off.
The so-called Committee Against Unfair Taxes was just a front,
organized and funded by the tobacco industry, a common tactic
used by the industry to hide its role in fighting tobacco taxes,
beyond just trying to overtly buy politicians off.
The fact that the industry fought tooth and nail suggests
that tobacco taxes can indeed affect consumption,
but much of the data on food taxes and subsidies have been based on models
or stated preferences to hypothetical scenarios,
with people just saying they'd change consumption patterns based on price,
but there hasn't been as much real-world data.
You can put people through fancy 3D supermarket simulators,
and find a 25% discount on fruits and veggies appears to boost
fruit and veggie purchases by 25%, nearly 2 pounds a week,
but virtual vegetables don't do you any good.
Does this work out in the real world?
Yes. South Africa's largest health insurance company
started offering 10 or 25% cash back on healthy food purchases
to hundreds of thousands of households— up to 500 bucks a month.
Why would they do that? Why would they give money away?
Because it works, apparently increasing the consumption
of fruits and vegetables, and whole grains, while decreasing the consumption
of foods high in added sugar, salt, and fat, including processed meats and fast food.
Subsidies are more popular than taxes though.
In Europe, a number of countries have instituted taxes
on sugary foods or salty foods.
But Denmark was the first to introduce a tax on saturated fat like meat and dairy,
but it only took the food industry about a year to squash it,
demonstrating that public health advocates are weak
in tackling the issues of corporate power, an enormous imbalance
between the influence exerted by public health professionals
compared to the political might of the food industry,
bringing to mind the fight over traffic light labeling on food,
that's way too easy to understand.
So the industry went nuts and spent more than a billion dollars
killing the proposal in favor of the
bring-your-calculator-to-the-grocery-store guideline daily amount labeling
to make it as confusing as possible.
Denmark ended up canceling the fat tax and shelving their sugar tax
because the farming and food company interests claimed
too many jobs would be lost if people ate healthier.
Apparently a healthy economy was more important than a healthy population.
Ironically it was abolished just when evidence of the effects started to appear.
The introduction of the saturated fat tax did end up contributing
to reducing the intake of saturated fat among Danish consumers
from some meat and dairy products, but not from sour cream.
Hmm, why?
Well, the public ended up eating so much more low-fat sour cream
that it ended up outweighing the smaller reduction in high-fat sour cream,
so you always have to think about the unintended consequences.
If people swap out sugary cookies for salty chips, for example,
it might not be doing the public's health many favors.
One field study of a tax on soda found that you can drop soft drink purchases,
at least in the short term,
but households may just end up buying more beer.