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Full Chapter Taxing Soda For Public Health A Canadian Perspective 1St Edition Yann Le Bodo PDF
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Yann Le Bodo · Marie-Claude Paquette
Philippe De Wals
Taxing Soda
for Public
Health
A Canadian Perspective
Taxing Soda for Public Health
Yann Le Bodo Marie-Claude Paquette
•
Philippe De Wals
123
Yann Le Bodo Philippe De Wals
Quebec Heart and Lung Institute Research Department of Social and Preventive
Centre Medicine
Laval University (Université Laval) Laval University (Université Laval)
Quebec City, QC Quebec City, QC
Canada Canada
Marie-Claude Paquette
Department of Nutrition, Faculty of
Medicine
University of Montreal (Université de
Montréal)
Montreal, QC
Canada
Corinna Hawkes
Professor of Food Policy
Centre for Food Policy
City University London
v
Preface
Although life expectancy in Canada is among the highest worldwide, the country is
concerned by the progression of non-communicable diseases (NCDs): cancers,
cardiovascular diseases, chronic respiratory diseases and diabetes are predominant
causes of mortality. Obesity, which contributes to some of these conditions, has
reached an alarming prevalence in both Canadian youth and adults. This situation
places an unprecedented sanitary and economic burden on our society. To tackle the
issue, there is strong evidence that, alongside regular physical activity, adopting and
maintaining a healthful diet is an important part of the solution. According to the
most recent nutrition surveys, Canadian eating habits leave room for improvements.
Adopting a healthy diet is a challenge: dietary behaviours are subject to a wide
array of conditions at individual and environmental levels including strong physi-
cal, political, economic and sociocultural influences. Consequently, the imple-
mentation of multiple healthy eating promotion strategies involving a diversity of
stakeholders is generally recommended. In a given context, however, the best
“mix” of cost-effective and applicable interventions to be implemented is debatable.
Of these interventions, this book addresses the rationale, the effectiveness and
the applicability of one of the most controversial: taxing soda. It emerged from a
comprehensive literature review performed by the first author as the first step of a
Ph.D. thesis in community health at Laval University (Université Laval), Quebec
City, Canada. The original aim of the thesis was to analyse the decision process that
led to the adoption of a soda tax in France in December 2011 and to draw lessons
that could inform stakeholders and decision-makers in the province of Quebec.
It appeared very quickly that the issue was relevant for a much larger audience
and that a comprehensive review adopting a public health perspective would be of
interest for the scientific community and public health authorities in Canada and
many other countries. Indeed, the topic has been extensively covered in
peer-reviewed scientific journals and in the media across the world, but there
have been few attempts: (1) to summarize available evidence in a book format,
(2) to comprehensively assemble evidence from a diversity of disciplines,
(3) to contextualize evidence at a country level (e.g. in Canada) and (4) to provide
vii
viii Preface
Yann Le Bodo received a Ph.D. fellowship from the Quebec Research Funds—
Society and Culture (Fonds de recherche du Québec—Société et culture) in the
framework of his research on sugar-sweetened beverage taxation led as a Ph.D.
student in community health at Laval University (Université Laval)’s Faculty of
Nursing. This work was undertaken at the Evaluation Platform on Obesity
Prevention (EPOP), supported by the Quebec Heart and Lung Institute, Laval
University (Université Laval) and the Lucie and André Chagnon Foundation.
Yann Le Bodo is grateful to his Ph.D. research director Philippe De Wals for his
continued support, as well as to his EPOP colleagues, in particular Nathalie Dumas,
Luc Ricard, José Massougbodji, Michael Gandonou, Maude Dionne and Ramona
Fratu for their advice and contributions to various aspects of his Ph.D. research.
Yann would also like to thank sincerely Philippe De Wals, Marie-Claude Paquette,
Emmanuel Guindon and Barbara von Tigerstrom for their most valuable contribu-
tions to this book. He also thanks Natalie Alméras, Maggie Vallières, Frédéric
Bergeron, Fabrice Étilé, France Gagnon, Chantal Blouin and Johanne Laguë for their
inspiring collaboration to connected parts of his Ph.D. research. Thanks also go to
the Quebec working group on sugar-sweetened beverages led by the Ministry of
Health and Social Services (Ministère de la Santé et des Services sociaux), for
having occasioned fruitful discussions and information-sharing on the issue in 2015.
This book consists in a review of a vast amount of studies and publications
performed by many scholars and organizations to whom the authors are grateful for
having provided much valuable information, concepts and ideas as well as inspi-
ration to organize and deliver this synthesis. Some of them occasionally shared key
publications and punctually commented specific sections of the manuscript, which
was very appreciated. From January 2012 to December 2015, parts of the work in
progress were presented to various local, national and international audiences
during classes, meetings and conferences. Informal discussions held with students,
xi
xii Acknowledgements
professionals and experts on these occasions were very beneficial. The authors also
sincerely thank Corinna Hawkes for having welcomed their invitation to write the
foreword of the book. Thanks also go to Martine Six for having helped revise the
final version of the manuscript and to Springer, in particular to Janet Kim, for their
confidence, responsiveness and professionalism along the editing and publishing
process.
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1.2.1 Theoretical Basis . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1.2.2 A “Realist” Review of Evidence . . . . . . . . . . . . . . . . 20
1.2.3 Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
1.2.4 Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
xiii
xiv Contents
Part IV Conclusion
15 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Appendix 1: Key Messages About the Relevancy to Tax
Sugar-Sweetened Beverages as Part of a Portfolio
of Nutrition-Enhancing Policies in Canadaa . . . . . . . . . . . 235
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Authors and Reviewers
xix
xx Authors and Reviewers
Reviewers
The authors are most grateful to Emmanuel Guindon and Barbara von Tigerstrom
for having reviewed and provided insightful comments and suggestions on several
draft versions of this book. It definitely contributed to improving the structure and
contents of the final product, whose authors remain responsible.
G. Emmanuel Guindon is the inaugural Centre for Health Economics and Policy
Analysis (CHEPA)/Ontario Ministry of Health and Long-Term Care Chair in
Health Equity, an assistant professor in the Department of Clinical Epidemiology
and Biostatistics and an associate member of the Department of Economics at
McMaster University. Emmanuel’s research interests include the economics of
health behaviours, equity in health and health care, health services research and
empirical health economics and policy. Through his research, education and service
activities, Emmanuel works closely with decision-makers in provincial govern-
ments as well as in national and international non-governmental organizations.
Email: emmanuel.guindon@mcmaster.ca.
xxiii
xxiv Abbreviations
Abstract Taxes altering the prices of less healthful foods have been increasingly
recommended as part of non-communicable disease and obesity prevention
strategies. Progressively, sodas or sugar-sweetened beverages (SSBs) have become
a target of particular interest and, over the last ten years, taxes have been reinforced
or newly imposed on these beverages in a growing number of countries.
Twenty-one cases of soda taxes are presented in this introduction. However, such
taxes remain controversial. Based on a realist review of literature and knowledge
synthesis techniques, this book attempts to provide answers to the following
question: Is it relevant to tax soda for public health in Canada? The findings are
subdivided into three parts focusing on: SSB taxation rationale (Part I), SSB tax-
ation impacts (Part II) and SSB taxation applicability (Part III).
1.1 Background
In 2011, for the second time in United Nations’ history,1 the General Assembly met
to address an alarming public health issue: the prevention and control of
non-communicable diseases (NCDs). The political declaration of this high-level
meeting called for an urgent international response (United Nations 2011). NCDs
were deemed to cause 68 % of the world’s 56 million deaths in 2012.
Cardiovascular diseases, cancer, diabetes and chronic respiratory diseases account
for 82 % of this burden (World Health Organization (WHO) 2014a). Although life
expectancy in Canada is among the highest worldwide, NCDs remain a threat as they
are estimated to represent 88 % of total deaths. Cancers (30 % of deaths), cardio-
vascular diseases (27 %), chronic respiratory diseases (7 %) and diabetes (3 %) are
predominant causes (WHO 2014b). About one in five Canadian adults live with at
least one of these chronic diseases, including one in 10 suffering from diabetes
(Public health agency of Canada (PHAC) 2015). Obesity is known to increase the
risk of a number of these conditions (American Institute for Cancer Research
1
After the special session held in 2001 on the human immunodeficiency virus (HIV)/acquired
immunodeficiency syndrome (AIDS).
2
These prevalences were established from direct measurements conducted for the Canadian Health
Measures Survey (CHMS). Here, obesity is defined according to the body mass index (BMI), which
is an indicator calculated by dividing an individual’s weight (kilograms) by its height (metres)
squared. In adults (age 18), obesity is defined by a BMI over 30 kg/m2. In youth, the same BMI
calculation applies, but the obesity threshold varies by age and sex to account for growth and
maturation. In this case, the 2007 WHO BMI age-/sex-specific cut-offs have been used to define
obesity threshold and calculate obesity prevalence in youth (Public health agency of Canada 2015).
3
Depending on the diseases included in the model.
4
Mozafarian (2014, p. 1307), commenting recent scientific evidence on cardiovascular health,
considers that such diets tend to be “neither extreme nor exceptional, but reasonable and consistent
with dietary guidelines (e.g. 5 daily servings of fruits and vegetables, 4 daily servings of whole
grains, and 2 weekly servings of fish)”.
1.1 Background 3
taxes altering the prices of less healthful foods have been increasingly recom-
mended as part of comprehensive NCD and obesity prevention5 strategies
(Gortmaker et al. 2011; Mozaffarian et al. 2012; WHO 2015b). The concept of
health-related food taxation emerged in the USA in the 1990s, in a context of rapid
and important increase of NCD prevalence. It referred to taxes imposed on the
manufacture or consumption of foods and beverages particularly dense in energy,
fat or sugar, with the explicit intention to earmark the proceeds for health promotion
purposes (Jacobson and Brownell 2000).
Progressively, sodas appeared as ideal candidates for taxation because of their
high sugar content, their poor nutritive value, the health risks related to their
overconsumption,6 the high intakes often observed in youth, and the aggressive
marketing practices of manufacturers (Brownell and Frieden 2009; Brownell et al.
2009; Lustig et al. 2012; Block and Willett 2013; Mytton 2015). Generally, tax
proposals particularly focus on sugar-sweetened beverages (SSBs). The precise
definition of these beverages varies in the literature, but generally converges to
designate non-alcoholic beverages containing added sugars.7
Over the last ten years, soda taxes8 have been reinforced or newly introduced in
a growing number of countries. Table 1.1 includes soda taxes that have been
attached to health considerations, be this in governmental position statements,
budgetary speeches or legislative texts.9 This means that other excise duties and
5
In this book, obesity prevention is used as a generic term encompassing all kinds of interventions on
lifestyle habits associated with weight problems, including physical activity and nutrition, as well as
environmental, social and other factors influencing physical activity and nutrition (EPOP 2015). Thus,
as in other key references, the prevention of overweight (25 BMI < 30, see footnote 1) is implicitly
included in the prevention of obesity (BMI 30) (Institute of Medicine (IOM) 2012, p. 289).
6
At individual level, we refer to “SSB overconsumption” as the daily consumption of SSB
resulting in a daily intake of added sugars that exceeds 10 % of daily energy intake (see Box 2.1).
This threshold is congruent with WHO recent recommendation to maintain the intake of free
sugars to fewer than 10 % of total energy intake (WHO 2015a).
7
In this book, please note that “sugar-sweetened beverages” (SSBs) include carbonated drinks,
fruit drinks, flavoured waters, energy drinks and sports drinks, as long as these beverages contain
added sugars. Our definition excludes bottled water, 100 % fruit juice, milk, sugar-sweetened
milks, non-calorically sweetened beverages (NCSBs), hot chocolate, and hot coffee-/tea-based
beverages (see Sect. 2.1).
8
In the context of nutrition policies, the term “soda,” although originally designating carbonated
beverage, frequently and commonly refers to sugar-sweetened beverage (SSB). In this book, both
terms are used in an interchangeable manner.
9
This list is not necessarily comprehensive. It was established along our realist review of evidence (see
Sect. 1.2). Cross-checks were made with other lists identified (European Commission 2012; OECD
2012; Ecorys 2014a; WHO 2015b; WCRF 2015) to favour exhaustiveness, accuracy and the most
up-to-date information. Documents referenced in English, French or Spanish have been considered.
4
Table 1.1 Cases of health-related taxes targeting non-alcoholic beverages across the world (dated December 2015)
Jurisdiction Adoptiona Health-related Targeted beveragesb Tax typec and rated Allocation of tax References
(world considerations revenues
region)
French 2002 Introduction of Sweetened drinks Excise taxation of 40 2002–2005: funding Thow et al. (2011),
Polynesia various taxes (on Pacific Francs of preventive health Snowdon and Thow
(Australasia) sweetened drinks, (CFP) (eq. 0.51 and “citizenship (2013)
beer, confectionery, CAD)/litre for projects”
ice cream) to sweetened drinks 2008: 80 % of tax
establish a manufactured locally; revenues earmarked
“preventive health import tax of 60 for the Ministry of
fund” addressing CFP (eq. 0.76 CAD)/ Health’s general
nutrition-related litre for imported budget
issues and NCDs sweetened drinks
Fiji 2006, Excise taxes enacted Soft drinks 5 % import excise tax Revenues collected Thow et al. (2011)
(Australasia) removed as part of a budgetary and domestic excise by the Fiji Islands’
in 2007 initiative. However, tax of 0.05 Fiji dollars Revenue and
prior to the (eq. 0.03 CAD)/litre Customs Authority,
implementation of the both introduced in with no specific
tax, Thow et al. 2006, but the information identified
(2011, p. 57) domestic tax was in terms of
highlight that replaced in 2007 with earmarking
“informal discussions a 3 % fiscal import
[occurred] between duty on raw materials
the Ministry of Health “for the purpose of
and Finance policy fairer administration
makers regarding the and collection of the
1
Disease committee”
(continued)
Table 1.1 (continued)
Jurisdiction Adoptiona Health-related Targeted beveragesb Tax typec and rated Allocation of tax References
(world considerations revenues
region)
Nauru 2007 Introduction of a New tax on all high-sugar 30 % customs and Contribution to the Thow et al. (2011),
1.1 Background
(Australasia) “sugar levy” for both drinks (including excise duty based on general budget of the Snowdon and Thow
financial and health carbonated soft drinks, existing fiscal state (2013)
reasons, including an cordials, flavoured milk and schemes applied to
attempt to drink mixes) and removal of tobacco, alcohol and
“discourage excessive a tax on bottled water petrol
consumption of
sugar” (Thow et al.
2011, p. 59)
Samoa 1984, Official objective to Soft drinks Excise taxation of No specific Thow et al. (2011)
(Australasia) revised in raise revenues for the 0.40 Tala (eq. 0.21 information identified
1998 and general budget of the CAD)/litre on
2008 state, although an domestic production
objective to “further and imported
support the beverages (5–8 %
Government’s drive of purchase price)
to improve health
outcomes for the
community” has also
been mentioned by
the finance minister in
2008 (Thow et al.
2011, p. 58)
(continued)
5
6
(Europe) restoration of excise sugar- and taxation of targeted provide revenues to Finance (2012,
taxes motivated by non-sugar-sweetened beverages from 0.045 the Finnish 2013), OECD
health considerations carbonated drinks), € (eq. 0.06 CAD)/ government. No (2012), Ecorys
and included within non-alcoholic fruit- and litre (since 1999) to evidence of (2014a)
(continued)
Introduction
Table 1.1 (continued)
Jurisdiction Adoptiona Health-related Targeted beveragesb Tax typec and rated Allocation of tax References
(world considerations revenues
region)
the “Act on excise vegetable-based drinks 0.075 € (eq. 0.11 earmarking for public
1.1 Background
It was finally better beverages, flavoured milk) price according to State (NB: Since Berardi et al. (2012),
recognized by the Berardi et al. 2012). 2013, all the revenue Chauliac (2014),
The rate is yearly goes to the National Ecorys (2014a),
(continued)
Introduction
Table 1.1 (continued)
Jurisdiction Adoptiona Health-related Targeted beveragesb Tax typec and rated Allocation of tax References
(world considerations revenues
region)
legislator as a way to adjusted in line with Health Insurance Ministère des
1.1 Background
raise fiscal revenues. the growth rate of the System) finances et des
consumer price index. comptes publics
In 2016, the soda tax (2015)
rate reached 0.0753 €/
litre
Cook 2012 New import duty Sugar-sweetened drinks Import duty of 15 % No specific Brown (2012),
Islands included in the with a subsequent information identified Snowdon and Thow
(Australasia) 2012/2013 budget 2 % rise per year. Not (2013)
and presented “[…] applicable to the
primarily as a public small local producers
health measure aimed
at increasing the cost
of sweetened drinks
to encourage
behavioural change”
(Brown 2012, p. 53)
Algeria 2012 Establishment of a Carbonated drinks Tax at a rate of 0.5 % Fiscal revenues Official Journal of the
(North national “Fund on the revenue of earmarked for cancer Algerian Republic
Africa) against cancer”, manufacturers and prevention, early (2012), Zikara
partially funded from importers of screening and (2012), Ferdi (2012)
taxes on alcohol, carbonated drinks treatment
tobacco-based
products, cell phone
operators and
carbonated drinks
(continued)
9
Another random document with
no related content on Scribd:
voor ruim dertig jaaren: te recht noemt de Dichter Willink dit
verdervelijk voordbrengsel van ’t menschlijk vernuft, eene stof
GESCHIEDENISSEN.
Deeze zijn, naar evenredigheid van het bevang der buurt, vrij
aanmerkelijk: door het reeds gemeld springen van de kruidstooven,
welken er weleer gevonden werden, werd de [5]buurt niet weinig
geteisterd; en het verval niet alleen, maar zelfs het verdwijnen van
verscheidene catoendrukkerijen, heeft haar voords mede eene zeer
gevoelige neep toegebragt: in 1732 onderging zij ook eene hevige
schrik door het afbranden van het nabij zijnde pesthuis, het welk
geheel door de vlamme verteerd werd, en welk onheil niet weinig in
akeligheid toenam, door de krankzinnigen, welken er in opgesloten
waren, gelijk het gebouw nog heden mede tot dat einde dient.
Omtrent den jaare 1750 had deeze buurt in haar bevang een
Fransche schouwburg, (die echter uit de stad zijn bestaan moest
trekken,) zij werd aangelegd ter plaatse alwaar men thans het
bekende Fort de Eendragt ziet; doch na verloop van weinige jaaren
werd zij door het vuur verteerd: op den grond werd het
tegenwoordige zwaare gebouw gesticht; en diende als toen voor
eene Porseleinbakkerij; doch deeze heeft mede niet veele jaaren
stand gehouden; de aanleggers verstonden de kunst van
Porceleinen te maaken niet genoeg om aan den kieschen smaak der
Hollanderen, die gewoon zijn aan het allerfraaiste geen gebrek te
hebben, al moest het ook van het andere einde der wereld hun
toegebragt worden, te voldoen: sedert heeft het gebouw tot een
ander einde gediend; voor weinige jaaren was er een groote
behangsel fabriek, enz. in geplaatst, doch dezelve heeft op dien
ongelukkigen grond almede geenen stand gegrepen; laatstlijk
hebben eenige Amsteldamsche boekverkopers het in huur gehad,
tot een magazijn, om er hunne bekende buitenverkoopingen van
copijen in te houden; doch ook dat gebruik heeft niet aan de
verwachting beantwoord, thans is het gekocht door den beroemden
Menschenvriend Jan van Mekeren, die het ter zijner eeuwige eer
tot een hofjen laat toebereiden.
LOGEMENTEN,
Uit het voorgaande blijkt, dat er voords veele herbergen van minder
aanzien gevonden worden. [8]
REISGELEGENHEDEN.
Aan den Overtoom voornoemd, vertrekt alle dagen een kaag op
Leiden: Maandag, Woensdag en Vrijdag vertrekt van daar ook een
schip naar Aalsmeer; alle dagen vaart een vragtschuit vise versa op
Amsteldam, en des Zomers Zondags en Maandags, een volkschuit,
heen en weêr, zo dikwijls er volks genoeg is, naar den stads
buitencingel.
Aan het meergemelde begin der buurte, is eene vry goede herberg;
voords vindt men in dezelve nog eenige weinige anderen, van
minderen rang.
DE BUITENVELDERSCHE POLDER,
OOK DE BUITENVELDERT
GENOEMD.
OVER-OUDERKERK
WAARDHUIZEN EN DE NES.
ZWALUWE-BUURT,
DE BOVENKERKER POLDER.
Zo genoemd, om dat er een paal staat, met een hand er aan, die
den weg naar de stad Leiden aanwijst; de bewooners van dit
buurtjen hebben in 1787, door de Pruissen, almede veel moeten
lijden.
Aan de
NOORDDAMMER BRUG,
Grooter is de
LEGMEER
Die zig uitstrekt van de Noorddammer brug, tot een quartier uur
gaans van Cudelstraat, zijnde eene langte van anderhalf uur gaans;
de bewooners bestaan meestal van de turfmaakerij. [1]
1 Deeze paal was in den jaare 1793 een zeer oud en onaanzienlijk stuk houts,
ten gezegden jaare is er een fraaje ronde steenen paal in de plaats gezet,
bovenaan rondsom denzelven leest men 100 Gaarden, zijnde de uitgestrektheid
van het gebied van Amsteldam, boven op den paal staat een fraaje bewerkte
kroon, ook pronkt hij met de wapens van Amsteldam en Amstelland, en laager
staat het voorgemelde jaartal der vernieuwinge MDCCXCIII. ↑
[Inhoud]
Gezigt van den zwaaren Brand te Amstelveen zo als het zig
vertoonde in den Nagt tussen den 25 en 26 Jny 1792.
Weinig dachten wij vóór een kort verloop van dagen, toen wij onze
beschrijving van Amstelveen, voor onze Nederlandsche stad- en
dorp-beschrijver, zamenstelden, dat wij door een der
beschreienswaardigste rampen, die, vooral opgezetenen, kunnen
treffen, gedrongen zouden worden, andermaal over dat plaatsjen te
moeten spreeken—weinig dachten wij dat het grijze dorpjen, ’t welk
wij toen van harten beklaagden wegens de doorgestaanen overlast
van den triumpheerenden soldaat, nu onze traanen ten ooge zouden
uitperssen, daar het, ten prooje gestaan hebbende aan den
jammerlijksten vuurnood, een tooneel oplevert dat niet dan met de
leevendigste ontferming beschouwd kan worden—een tweede reden,
waarom men dat dorpjen voortaan met recht het rampspoedig
Amstelveen mag noemen.