Healthy food subsidies and unhealthy food taxation: A systematic review of the evidence

Highlights

• Literature review of evidence to assess the health effect of food subsidies/taxes.

• Review shows subsidies/taxation policies can change population dietary behaviors.

• Maximum success achieved when food taxes/subsidies are at least 10–15% and used together.

Abstract

The Global Burden of Disease Study and related studies report unhealthy diet is the leading risk for death and disability globally. Given the evidence associating diet and non-communicable diseases (NCDs), international and national health bodies including the World Health Organization and United Nations have called for population health interventions to improve diet as a means to target NCDs. One of the proposed interventions is to ensure healthy foods/beverages are more accessible to purchasers and unhealthy ones less accessible via fiscal policy, namely taxation and subsidies. The objective of this systematic review was to evaluate the evidence base to assess the effect of healthy food/beverage subsidies and unhealthy food/beverage taxation. A comprehensive review was conducted by searching PubMed, Medline, and Google Scholar for peer-reviewed publications and seventy-eight studies were identified for inclusion in this review. This review was performed in keeping with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Although moderate in quality, there was consistent evidence that taxation and subsidy intervention influenced dietary behaviors. The quality, level and strength of evidence along with identified gaps in research support the need for further policies and ongoing evaluation of population-wide food/beverage subsidies and taxation. To maximize success and effect, this review suggests that food taxes and subsidies should be a minimum of 10 to 15% and preferably used in tandem. Implementation of population-wide polices for taxation and subsides with ongoing evaluation of intended and unintended effects are supported by this review.

Introduction

Preventable diet-related non-communicable health risks and diseases (NCDs), such as obesity, hypertension, heart disease, stroke, diabetes, kidney disease, or cancer, continue to increase globally [1], [2], [3], [4], [5], [6], [7], [8]. These largely result from unhealthy lifestyles and cost billions of dollars every year threatening economies and the sustainability of health care systems around the world [1]. NCDs account for over 60% of deaths and it is estimated 40% of these NCD-related deaths are attributed to dietary factors [6], [9], [10], [11], [12], namely: lack of fruits and vegetables, excess intakes of sodium, sugar-sweetened beverages, and saturated fats and trans-fatty acids, much of which is added during food processing [4], [7], [13], [14], [15], [16], [17], [18]. To reduce the burden of NCDs, population-wide dietary interventions are recommended [5]. Food subsidies and/or higher pricing (taxation) are two potential population-wide interventions that can enhance healthier eating through swaying of dietary behaviors. However, implementation, to include legislative approval and industry proponents, remains a barrier beyond the scope of this review to explore.