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      The Impact of a Tax on Sugar-Sweetened Beverages on Health and Health Care Costs: A Modelling Study

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          Abstract

          This paper aims to estimate the consequences of an additional 20% tax on sugar-sweetened beverages (SSBs) on health and health care expenditure. Participants were adult (aged > = 20) Australians alive in 2010, who were modelled over their remaining lifetime. We used lifetable-based epidemiological modelling to examine the potential impact of a 20% valoric tax on SSBs on total lifetime disability-adjusted life years (DALYs), incidence, prevalence, and mortality of obesity-related disease, and health care expenditure. Over the lifetime of adult Australian alive in 2010, seemingly modest estimated changes in average body mass as a result of the SSB tax translated to gains of 112,000 health-adjusted life years for men (95% uncertainty interval [UI]: 73,000–155,000) and 56,000 (95% UI: 36,000–76,000) for women, and a reduction in overall health care expenditure of AUD609 million (95% UI: 368 million– 870 million). The tax is estimated to reduce the number of new type 2 diabetes cases by approximately 800 per year. Twenty-five years after the introduction of the tax, there would be 4,400 fewer prevalent cases of heart disease and 1,100 fewer persons living with the consequences of stroke, and an estimated 1606 extra people would be alive as a result of the tax. The tax would generate an estimated AUD400 million in revenue each year. Governments should consider increasing the tax on sugared drinks. This would improve population health, reduce health care costs, as well as bring in direct revenue.

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          Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis

          Background Excess intake of sugar sweetened beverages (SSBs) has been shown to result in weight gain. To address the growing epidemic of obesity, one option is to combine programmes that target individual behaviour change with a fiscal policy such as excise tax on SSBs. This study evaluates the literature on SSB taxes or price increases, and their potential impact on consumption levels, obesity, overweight and body mass index (BMI). The possibility of switching to alternative drinks is also considered. Methods The following databases were used: Pubmed/Medline, The Cochrane Database of Systematic Reviews, Google Scholar, Econlit, National Bureau of Economics Research (NBER), Research Papers in Economics (RePEc). Articles published between January 2000 and January 2013, which reported changes in diet or BMI, overweight and/or obesity due to a tax on, or price change of, SSBs were included. Results Nine articles met the criteria for the meta-analysis. Six were from the USA and one each from Mexico, Brazil and France. All showed negative own-price elasticity, which means that higher prices are associated with a lower demand for SSBs. Pooled own price-elasticity was -1.299 (95% CI: -1.089 - -1.509). Four articles reported cross-price elasticities, three from the USA and one from Mexico; higher prices for SSBs were associated with an increased demand for alternative beverages such as fruit juice (0.388, 95% CI: 0.009 – 0.767) and milk (0.129, 95% CI: -0.085 – 0.342), and a reduced demand for diet drinks (-0.423, 95% CI: -0.628 - -1.219). Six articles from the USA showed that a higher price could also lead to a decrease in BMI, and decrease the prevalence of overweight and obesity. Conclusions Taxing SSBs may reduce obesity. Future research should estimate price elasticities in low- and middle-income countries and identify potential health gains and the wider impact on jobs, monetary savings to the health sector, implementation costs and government revenue. Context-specific cost-effectiveness studies would allow policy makers to weigh these factors.
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            Cost Effectiveness of a Sugar-Sweetened Beverage Excise Tax in the U.S.

            Reducing sugar-sweetened beverage consumption through taxation is a promising public health response to the obesity epidemic in the U.S. This study quantifies the expected health and economic benefits of a national sugar-sweetened beverage excise tax of $0.01/ounce over 10 years.
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              Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis.

              Intervention strategies are available for reducing the high global burden of hazardous alcohol use as a risk factor for disease, but little is known about their potential costs and effects at a population level. This study set out to estimate these costs and effects. Analyses were carried out for 12 epidemiological World Health Organization subregions of the world. A population model was used to estimate the impact of evidence-based personal and nonpersonal interventions--including brief physician advice, taxation, roadside random breath testing, restricted sales access and advertising bans. Costs were measured in international dollars (I$); population-level intervention effects were gauged in terms of disability-adjusted life years (DALYs) averted. Average and incremental cost-effectiveness ratios (CERs) were computed. The most costly interventions to implement are brief advice in primary care and roadside breath testing of drivers. In populations with a high prevalence of heavy drinkers (more than 5%, such as Europe and North America), the most effective and cost-effective intervention was taxation (more than 500 DALYs averted per 1 million population; CER < I$500 per DALY averted). In populations with a lower prevalence of heavy drinking, however, taxation is estimated to be less cost effective overall than other, more targeted strategies, such as brief physician advice, roadside breath testing and advertising bans. The most efficient public health response to the burden of alcohol use depends on the prevalence of hazardous alcohol use, which is related to overall per capita consumption. Population-wide measures, such as taxation, are expected to represent the most cost-effective response in populations with moderate or high levels of drinking, whereas more targeted strategies are indicated in populations with lower rates of hazardous alcohol use.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                13 April 2016
                2016
                : 11
                : 4
                : e0151460
                Affiliations
                [1 ]School of Public Health, The University of Queensland, Brisbane, Australia
                [2 ]WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia
                [3 ]Obesity Policy Coalition/Cancer Council Victoria, Melbourne, Australia
                Central Queensland University, AUSTRALIA
                Author notes

                Competing Interests: Two of the authors (JM, NA) are employed by the Obesity Policy Coalition.

                Conceived and designed the experiments: JM GS JLV. Performed the experiments: JLV GS. Analyzed the data: JLV GS. Contributed reagents/materials/analysis tools: JLV GS. Wrote the paper: JLV GS JM NA.

                Article
                PONE-D-15-40124
                10.1371/journal.pone.0151460
                4830445
                27073855
                58435097-7c83-4d17-bca7-ddfcdfc9828e
                © 2016 Veerman et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 September 2015
                : 28 February 2016
                Page count
                Figures: 5, Tables: 1, Pages: 10
                Funding
                This work was supported by the Obesity Policy Coalition and by NHMRC funding for the Centre for Research Excellence in Obesity Policy and Food Systems (APP1041020). GS is the recipient of an Australian Research Council Discovery Early Career Researcher Award (project number DE160100307). Two of the authors (JM, NA) are employed by the Obesity Policy Coalition. The NHMRC was not involved in the study or the reporting.
                Categories
                Research Article
                Social Sciences
                Political Science
                Public Policy
                Taxes
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
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                Body Mass Index
                Social Sciences
                Economics
                Health Economics
                Medicine and Health Sciences
                Health Care
                Health Economics
                People and Places
                Geographical Locations
                Oceania
                Australia
                Biology and Life Sciences
                Nutrition
                Medicine and Health Sciences
                Nutrition
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                Population Groupings
                Age Groups
                Adults
                Medicine and Health Sciences
                Cardiovascular Medicine
                Cardiovascular Diseases
                Custom metadata
                The appendix details the data sources, which are all from published research papers or publicly available sources. The model is available in the Supporting Information files.

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