Dr. Torben Jorgensen
Taxing unhealthy food and drinks to improve health O. T. Mytton, D. Clarke, M. Rayner BMJ 2012; 344: e2931
This very important paper summarises the available evidence on the effect of taxation on unhealthy foods and drinks, and highlights a number of problems in the debate. Whereas taxation on tobacco and alcohol is reasonable straightforward, it is stressed that taxation of unhealthy foods are much more complex. Taxing specific items as e.g. sugar may lead to fall in co-consumed items and rise in consumption of other goods, which can make it difficult to evaluate the effect. Many fiscal interventions in the food market have been unrelated to health, and only recently taxation has been used as an argument to increase health. The change may be stimulated by the UN high level summit on non-communicable diseases last year, where a role for food taxes was recognised, which gained some interest among politicians. The authors argue that instead of focusing on specific food items, we should use a broader term: Health related food taxes, which will bring the area more in line with taxation of tobacco and alcohol.
The authors summarise the literature within three areas: natural experiments, controlled trials and modelling studies. The main impression from all the different study designs is that health related food taxes could improve health. The taxation should be at least 20 % to obtain an effect. Furthermore it is speculated that the taxation should be used for subsidies on healthy foods (like fruit and vegetables) and to treat diet related diseases (which was very much favoured in an opinion poll from US). Finally, there was some evidence that food taxation had the potential to reduce social inequality in health.
These kinds of analyses are highly relevant within the area of public health. As pointed out in the article the industry is not interested in reduction of unhealthy foods and therefore ague against it. This was also seen with the tobacco industry, and unfortunately all industries seem alike in this respect. Furthermore, the article has a very important message to government that it is necessary to use the right arguments for taxes. It could be made even more explicit by stressing that taxes should not be used to improve the income of a government (an argument which is often used) but to improve public health. Most probably people will be more in favour of taxes on unhealthy foods if they are combined with subsidies on the healthy food, which will balance the economy of a family, who at the same time will eat healthier.
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