Fat tax or thin subsidy? How price increases and decreases affect the energy and nutrient content of food and beverage purchases in Great Britain.

Suboptimal diet is a leading risk factor for early death and disability globally. Changing food prices via tax or subsidy policies is often recommended to improve diets, particularly increasing the relative price of sugar-sweetened beverages to reduce sugar consumption. Less evidence exists on how such policies, if applied across a wide range of foods and beverages, could affect purchases and diet quality. Using home-scan data from a sample of 26,799 households in Great Britain (2012-2013) we estimate separate demand elasticities for price increases and decreases using a reference-price dependent demand model, to simulate the impact of a 20% price change on purchases of energy and nutrients from 26 healthier and less healthy food groups that make up the full basket of purchases. Where asymmetry exists between elasticity of price increase and decrease, household response to price increases is stronger. Households with low socio-economic status (SES) respond to price changes in either direction more strongly than high-SES, especially for less healthy foods. On average, energy and nutrient content of take-home purchases were near or above reference daily intake levels. The combined effect of increasing the price of all less healthy foods, and decreasing the price of all healthier foods, led to an overall improvement with a net reduction in energy (by 67.6kcal per capita/day), sugar (6.3g), salt (0.21g) and saturated fat (2.3g) content, and a net increase in protein (3.4g) and fibre (0.9g) content of purchases. From individual food groups, the greatest reduction in energy, sugar and saturated fat content was observed for price increases in sweet snacks, desserts and puddings, and fats and oils. Dietary quality of the purchases of low-SES households generally improved most. Our findings support the view that price change policies can lead to dietary improvements, if they are based on the healthiness of food and beverages

How much priority is given to nutrition and health in the EU Common Agricultural Policy?

Agriculture in the European Union (EU) is strongly influenced by the Common Agricultural Policy (CAP). There have been repeated calls for CAP to address nutrition-related health, particularly obesity and non-communicable disease (NCD) in the EU. However, aligning agricultural policy such as CAP with nutrition is complex, not least because the aims of agricultural policy are predominantly economic, presenting a challenge for developing coherence between agricultural trade and health policy. This research examined the political priority given to nutrition-related health concerns within CAP to date, and the solutions suggested by agricultural, trade and health policy-makers and public health nutrition advocates, via interviews of 20 high-level participants from respective sectors. The participants provided diverse perspectives, often varying by sector and institution, on the connections between agricultural policy and nutrition-related health, the extent to which nutrition concerns have "been addressed via CAP and whether CAP is an appropriate and effective policy approach to improve nutrition-related health in the EU in the future. The key findings suggest the need for communication and agreement of clear high-level nutrition guidelines, clarity on the EU mandate to address nutrition-related health concerns via policy, and stronger engagement of civil society in the issues if CAP is to address nutrition more than it is doing currently. The difference in worldviews between agricultural/trade representatives, and those from public health, also needs to be addressed. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.orgilicenses/by-nc-nd/4.0/)

Viewpoint: Soda taxes – Four questions economists need to address

The popularity of soda taxes as a public health policy has grown rapidly in the last few years. While the evidence that the tax works in reducing the purchases of soda is emerging, there are a number of questions that are yet to be answered before the broader effectiveness of this measure can be determined. Beyond health effects, there is more specifically a need to better understand the economic mechanisms of change, redistributive effects, as well as causal and spillover effects in food systems and economy more broadly

Estimating the Relationship between Food Prices and Food Consumption—Methods Matter

Concerns about the growing prevalence of obesity worldwide have led researchers and policy makers to investigate the potential health impact of fiscal policies such as taxes on unhealthy foods. A common instrument used to measure the relationship between food prices and food consumption is the price elasticity of demand. Using meta-regression analysis we assessed how differences in methodological approaches to estimating demand affected food price elasticities. Most methodological differences had a statistically significant impact on elasticity estimates, which stresses the importance of using meta-estimates or testing the sensitivity of simulation outcomes to a range of elasticity parameters before drawing policy conclusions

Correction: Are sweet snacks more sensitive to price increases than sugar-sweetened beverages: analysis of British food purchase data.

Smith RD, Cornelsen L, Quirmbach D, et al. Are sweet snacks more sensitive to price increases than sugar-sweetened beverages: Analysis of British food purchase data. BMJ Open 2018;8:e019788. doi: 10.1136/bmjopen-2017-019788 The sentence referring to bottom left panel on Figure 1 should say: 'A price increase for chocolate and confectionary items is associated with small but significant decreases across all soft drinks (0.6-0.8% for 10% price increase) as well as biscuits (1.2%), cakes (1.6%) and savoury snacks (0.3%)' Instead of: 'A price increase for chocolate and confectionary items is associated with small but significant decreases across all soft drinks (0.6-0.8% for 10% price increase) as well as biscuits and cakes (1.2%), and savoury snacks (1.6%)'

Have socio-economic inequalities in sugar purchasing widened? A longitudinal analysis of food and beverage consumer data from British households, 2014-2017.

OBJECTIVE: To examine socio-economic inequalities in decreases in household sugar purchasing in Great Britain (GB). DESIGN: Longitudinal, population-based study. SETTING: Data were obtained from the GB Kantar Fast-Moving Consumer Goods (FMCG) panel (2014-2017), a nationally representative panel study of food and beverages bought and brought into the home. We estimated changes in daily sugar purchases by occupational social grade from twenty-three food groups, using generalised estimating equations (household-level clustering). PARTICIPANTS: British households who regularly reported food and beverages to the GB Kantar FMCG (n 28 033). RESULTS: We found that lower social grades obtained a lower proportion of sugar from healthier foods and a greater proportion of sugar from less healthy foods and beverages. In 2014, differences in daily sugar purchased between the lowest and the highest social grades were 3·9 g/capita/d (95 % CI 2·9, 4·8) for table sugar, 2·4 g (95 % CI 1·8, 3·1) for sugar-sweetened beverages, 2·2 g (95 % CI 1·5, 2·8) for chocolate and confectionery and 1·0 g (95 % CI 0·7, 1·3) for biscuits. Conversely, the lowest social grade purchased less sugar from fruits (2·1 g (95 % CI 1·5, 2·8)) and vegetables (0·7 g (95 % CI 0·5, 0·8)) than the highest social grade. We found little evidence of change in social grade differences between 2014 and 2017. These results suggest that recent overall declines in sugar purchases are largely equally distributed across socio-economic groups. CONCLUSIONS: This suggests that recent population-level policy activity to reduce sugar consumption in GB does not appear to exacerbate or reduce existing socio-economic inequalities in sugar purchasing. Low agency, population-level policies may be the best solution to improving population diet without increasing inequalities

Framing and signalling effects of taxes on sugary drinks: a discrete choice experiment among households in Great Britain

Taxes on sugar-sweetened beverages (SSBs) are in place in many countries to combat obesity with emerging evidence that these are effective in reducing purchases of SSBs. In this study, we tested whether signalling and framing the price increase from an SSB tax explicitly as a health-related, earmarked measure reduces the demand for SSBs more than an equivalent price increase. We measured the demand for non-alcoholic beverages with a discrete choice experiment (DCE) administered online to a randomly selected group of n = 603 households with children in Great Britain (GB) who regularly purchase SSBs. We find a suggestive evidence that a price increase leads to a larger reduction in the probability of choosing SSBs when it is signalled as a tax and framed as a health-related and earmarked policy. Respondents who did not support a tax on SSBs, who were also more likely to choose SSBs in the first place, were on average more responsive to a price increase framed as an earmarked tax than those who supported the tax. The predictive validity of the DCE, to capture preferences for beverages, was confirmed using actual purchase data. The findings imply that a well-signalled and earmarked tax on SSBs could improve its effectiveness at reducing the demand

Evaluating Integrated Surveillance for Antimicrobial Use and Resistance in England: A Qualitative Study.

Integrated surveillance systems for antimicrobial use (AMU) and antimicrobial resistance (AMR) require regular evaluation to ensure the effectiveness and efficiency of the system. An important step in the evaluation is to choose an appropriate tool for the purpose of the evaluation. The "Integrated Surveillance System Evaluation" (ISSE) framework is a conceptual framework that was developed to evaluate One Health (OH) integration in surveillance system for AMU/AMR. This study aimed to evaluate the performance and value of integrated surveillance system for AMU/AMR in England by applying the ISSE framework, which was used to develop data collection protocols and define the study design. A qualitative study using semi-structured interviews was conducted to collect the data and analyse it thematically. Eighteen stakeholders from human, animal, food and environment sectors that are involved in AMU/AMR surveillance were interviewed. Four main themes emerged from the analysis: (1) Cross-sectoral integration in the surveillance system for AMU/AMR; (2) Production of OH outputs and outcomes; (3) Drivers and barriers to cross-sectoral collaboration; and 4) Need for more cross-sectoral collaboration. The findings showed that there were links between integrated surveillance information, decision making and interventions. However, there were only few OH examples, such as the UK AMR contingency plan, where the potential of cross-sectoral collaboration was fully exploited. A lot of the benefits described were related to the generation of information and increase in knowledge and understanding without links to how the information generated was used. While these intangible benefits have a value on their own, being able to link surveillance information and mitigation measures would help to enhance the value of integrated surveillance. In terms of improvement, the main areas identified were the development of more harmonised methods for data collection and analysis, provision of resources dedicated to cross-sectoral collaboration, improved coordination, and collection of surveillance data from the environment and from companion animals. By identifying links between OH surveillance information produced and various outputs and outcomes; this study helped to understand the wider benefits of integrated surveillance for AMU/AMR in England and provided insights on how the system could be improved and efficiency increased

Are sweet snacks more sensitive to price increases than sugar-sweetened beverages: analysis of British food purchase data.

OBJECTIVES: Taxing sugar-sweetened beverages (SSBs) is now advocated, and implemented, in many countries as a measure to reduce the purchase and consumption of sugar to tackle obesity. To date, there has been little consideration of the potential impact that such a measure could have if extended to other sweet foods, such as confectionery, cakes and biscuits that contribute more sugar to the diet than SSBs. The objective of this study is to compare changes in the demand for sweet snacks and SSBs arising from potential price increases. SETTING: Secondary data on household itemised purchases of all foods and beverages from 2012 to 2013. PARTICIPANTS: Representative sample of 32 249 households in Great Britain. PRIMARY AND SECONDARY OUTCOME MEASURES: Change in food and beverage purchases due to changes in their own price and the price of other foods or beverages measured as price elasticity of demand for the full sample and by income groups. RESULTS: Chocolate and confectionery, cakes and biscuits have similar price sensitivity as SSBs, across all income groups. Unlike the case of SSBs, price increases in these categories are also likely to prompt reductions in the purchase of other sweet snacks and SSBs, which magnify the overall impact. The effects of price increases are greatest in the low-income group. CONCLUSIONS: Policies that lead to increases in the price of chocolate and confectionery, cakes and biscuits may lead to additional and greater health gains than similar increases in the price of SSBs through direct reductions in the purchases of these foods and possible positive multiplier effects that reduce demand for other products. Although some uncertainty remains, the associations found in this analysis are sufficiently robust to suggest that policies-and research-concerning the use of fiscal measures should consider a broader range of products than is currently the case