Setting: Communities & Government

Cost-Effectiveness of a Sugar-Sweetened Beverage Excise Tax in the U.S.

Implementing a national sugar-sweetened beverage excise tax could substantially reduce body mass index (BMI) and health care expenditures over 10 years, and increase healthy life expectancy in the US.

Long MW, Gortmaker SL, Ward ZJ, Resch SC, Moodie ML, Sacks G, Swinburn BA, Carter RC, Claire Wang Y. Cost Effectiveness of a Sugar-Sweetened Beverage Excise Tax in the U.S. Am J Prev Med. 2015 Jul;49(1):112-23. doi: 10.1016/j.amepre.2015.03.004.

The close link between consumption of sugar-sweetened beverages (SSB) and excess weight gain, diabetes, and cardiovascular disease has led to public health recommendations for higher taxes on unhealthy drinks like soda and sports drinks. While a number of studies have found that higher beverage taxes and prices are associated with significantly lower BMI, this is the first study to estimate the cost effectiveness of implementing a $0.01 per ounce SSB excise tax in the US.

By using a simulation model, the study found that implementing the tax nationally would cost $51 million in the first year and would reduce SSB consumption by 20%, substantially reducing BMI among both youth and adults. Over a 10-year period, the tax would avert 101,000 disability-adjusted life years, gain 871,000 quality-adjusted life years, and result in $23.6 billion in healthcare cost savings. Annually, the tax would generate revenue totaling $12.5 billion.

Rows of soda bottles“We know that the current level of sugar-sweetened beverage consumption in the United States is doing real harm to our children, our families, and our society by increasing the risk of obesity, diabetes, and cardiovascular disease, leading to increased healthcare costs and early deaths,” says lead study author Michael Long, ScD, a postdoctoral research fellow at the Harvard Prevention Research Center. “The question is: what are we going to do about it? Our study shows that a small tax on the production of these beverages can prevent obesity, save lives, and reduce healthcare costs for the country. This is a low-cost prevention strategy that could also raise revenue to fund community programs to promote healthy eating and physical activity.”

In contrast to sales taxes that are collected from the consumer at time of purchase, this per-volume excise tax would apply to producers and distributors of sugar-sweetened beverages and would be incorporated into shelf prices, leading to an estimated 16% total price increase for sodas, sports drinks, fruit drinks, and any other beverages with added caloric sweeteners.

Implementing an excise tax on sugar-sweetened beverages could serve as a powerful social signal to reduce sugar consumption through additional individual behavioral and policy changes. In the ongoing debate over policy approaches to curb the obesity epidemic in the US, this analysis provides important new information to policymakers and the public regarding the substantial savings in both human health and government expenditures that could be achieved.

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BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth

CHOICES research found that eliminating the tax subsidy of TV advertising costs for unhealthy food and beverages advertised to children and adolescents could be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.

Sonneville KR, Long MW, Ward ZJ, Resch SC, Wang YC, Pomeranz JL, Moodie ML, Carter R, Sacks G, Swinburn BA, Gortmaker SL. BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth. Am J Prev Med. 2015 Jul;49(1):124-34. doi: 10.1016/j.amepre.2015.02.026.

Every year, children in the US are exposed to thousands of food-related TV advertisements, most of which promote nutritionally poor foods and drinks. Despite changes in media consumption, TV remains the predominant platform to reach youth, and the advertising industry knows it. Food marketers spend millions of dollars on youth-directed television each year, and these advertising expenditures are currently treated by the US government as an ordinary business expense. In 2009, for example, the food and beverage industry received a tax subsidy of nearly $80 million for the $633 million spent on TV advertising to children.

With factors such as the US Constitution’s protection of marketing as commercial speech and the government’s reluctance to regulate even minimal restrictions on advertising, eliminating or amending the tax deduction available to food companies for the costs of advertising to children has been proposed.

Children crowded around an iPad“By changing the tax treatment of advertising expenses, the food industry will have less incentive to advertise unhealthy foods and drinks to kids,” says lead author Kendrin Sonneville, ScD, RD, Director of Nutrition Training in the Division of Adolescent Medicine at Boston Children’s Hospital.

The study intervention involved the elimination of this tax subsidy, applying to television programming watched on traditional TV and to television advertising aired during children’s programming, reaching nearly 74 million youth between the ages of two to 19. By using a simulation model, the researchers estimated that the intervention would reduce an aggregate 2.13 million BMI units in the population, costing $1.16 per BMI unit reduced. Over a 10-year period, the intervention would result in $352 million in healthcare cost savings and gain 4,538 quality-adjusted life years (QALYs).

While the effects of the intervention may be small at the individual level, such a policy could have substantial impact on healthcare expenditure at the population level. Although the policy would likely be met with opposition from the food industry, eliminating the tax subsidy of advertising expenses would also generate tax revenue and is likely to receive strong public support. The study provides important information for a feasible approach to reducing children’s advertising exposure.

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Systematic Review and Meta-Analysis of the Impact of Restaurant Menu Calorie Labeling

Menu calorie labeling identified as a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.

Long MW, Tobias DK, Cradock AL, Batchelder H, Gortmaker SL. Systematic Review and Meta-analysis of the Impact of Restaurant Menu Calorie Labeling. Am J Public Health. 2015 May;105(5):e11-24. doi: 10.2105/AJPH.2015.302570. Epub 2015 Mar 19.

A number of studies have examined the relationship between menu calorie labeling and the calories consumers ordered or purchased in a variety of settings with differing results. To get a combined effect estimate for modeling the cost effectiveness of the federal menu labeling policy, CHOICES researcher Dr. Michael Long conducted a systematic review and meta-analysis. While the meta-analysis evidence does not support a significant impact on calories ordered, menu calorie labeling is a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.

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