This timely reference analyzes the rationale, impact, and feasibility of taxation of sugar-sweetened beverages (SSBs) as a public health measure to contribute curbing obesity and diabetes rates, specifically in Canada. It presents the pros and cons of taxing soda, with the latest data on adverse health effects of its consumption, plus the various business and political issues surrounding the contentious proposition. Reviewed research is multidisciplinary, spanning health and medicine to ethics, economics, and law. Conclusions and caveats are clear and presented at a comfort level for the general reader. The result is a blueprint for analyzing the relevancy of taxes on sweetened soft drinks or other low-nutrition food products, plus a trove of valuable insights into aspects of government decision-making and consumer food behavior.
Included in the coverage: * Reasons for specifically targeting SSBs * SSB taxation as a public health policy instrument * Effects of SSB taxation on energy intakes and population health * Potential undesirable effects relating to SSB taxation * Social and political acceptability of SSB taxation * Evaluability of SSB taxation Taxing Soda for Public Health will interest policymakers, public health professionals, advocacy groups, and researchers at the Canadian and international levels (e.g., in areas such as public health, nutrition, food and health policies, health economics, and evaluation), as well as students and all other parties interested in nutrition policies.
Summary 1. Introduction 2. Methods2.1 Theoretical basis2.2 A 'realist' review of evidence2.3 Data collection2.4 Data analysis 3. Why - Rationale3.1 Reasons for targeting specifically SSB (sugar sweetened beverages) 3.1.1 SSB and health risks 3.1.2 SSB consumption and marketing trends 3.1.3 Considerations on some other non-alcoholic beverages 3.1.4 Concluding comments3.2 Merits of SSB taxation as a public health policy instrument 3.2.1 Price, a key determinant of food habits 3.2.2 Taxing SSB as part of a comprehensive strategy 3.2.3 Learning from tobacco taxation 3.2.4 Taxation, a highly cost-effective option 3.2.5 Concluding comments3.3 Economic rationale for taxation and ethical concerns 3.3.1 Economic debates about the normative justification of SSB taxation 3.3.2 Ethical concerns surrounding freedom of choice and autonomy 3.3.3 Concluding comments3.4 Clarifying SSB taxation logics 4. What - Impact4.1 Tax effects on SSB prices 4.1.1 Factors that may impair SSB tax shift onto prices 4.1.2 Empirical evidence 4.1.3 Additional proposals to secure the pass-through 4.1.4 Concluding comments4.2 Tax effects on SSB demand 4.2.1 Findings from experimental studies 4.2.2 Factors that may impair tax effects on demand in the 'real world' 4.2.3 'Real-world' price-elasticity of SSB demand 4.2.4 Preliminary evidence from taxes implemented across the world 4.2.5 May we miss our core target? 4.2.6 Concluding comments4.3 Tax effects on energy intakes and population health 4.3.1 Overview of substitution concerns 4.3.2 Results from public health modeling studies 4.3.3 Results from economics modeling studies 4.3.4 Preliminary evidence from taxes implemented across the world 4.3.5 Concluding comments4.4 Potential inequities related to SSB taxation 4.4.1 Distribution of changes in SSB intakes 4.4.2 Distribution of the financial contribution to tax revenues 4.4.3 Distribution of effects according to SSB consumption levels 4.4.4 Equity concerns and acceptability of SSB taxation 4.4.5 Concluding comments 4.5 Potential undesirable effects related to SSB taxation 4.5.1 Tax-related administration costs for industries 4.5.2 Tax impact on profitability 4.5.3 Tax impact on employment 4.5.4 Tax impact on investments 4.5.5 Tax impact on competitiveness 4.5.6 Tax impact on cross-border trade 4.5.7 Concluding comments4.6 Raising fiscal revenues from SSB taxation 4.6.1 Confidence and estimations 4.6.2 Justification for targeting SSB specifically 4.6.3 Pursuing both fiscal and behavioural logics may be paradoxical 4.6.4 The importance of earmarking tax revenues to health promotion 4.6.5 Concluding comments4.7 Potential 'signal' effects from SSB taxation 4.7.1 An 'alarm-signal' to the population 4.7.2 A 'coercive signal' to manufacturers 4.7.3 Arguments for a comprehensive 'de-normalization' strategy 4.7.4 The complex evaluation of signal effects 4.7.5 Concluding comments 5. How - Applicability5.1 Legal and administrative feasibility 5.1.1 The complexity of sweetener inputs' taxation 5.1.2 Excise taxes commonly preferred to sales taxes 5.1.3 How feasible is it to rely on sales and/or excise SSB taxes in Canada? 5.1.4 Concerns on the scope of the tax and its rate 5.1.5 Concluding comments5.2 Social and political acceptability 5.2.1 International perspective 5.2.2 Canadian experts 5.2.3 Canadian civil society 5.2.4 Canadian elected representatives 5.2.5 Canadian public opinion 5.2.6 Importance of a constructive dialogue 5.2.7 Concluding comments5.3 Evaluability 5.3.1 Importance of SSB taxation evaluation 5.3.2 Evaluation of a price-induced behavioural logic 5.3.3 Evaluation of a fiscal logic 5.3.4 Evaluation of a signal-induced de-normalization logic 5.3.5 The challenge of robust economic evaluations 5.3.6 Concluding comments 6. Discussion6.1 Proposal of a multi-dimensional evidence-based framework6.2 Conclusion 7. Bibliography