What do we know about Sugar- Click to edit Master title Sweetened Beverage Taxes? style Click to edit Master subtitle style Kristine Madsen, MD, MPH Childhood Obesity Conference, 2019
Outline Strategic Research How sugar-sweetened beverage (SSB) taxes work Evidence to date on SSB taxes Revisit strategy
Strategic research Click to edit Master title style Click to edit Master subtitle style
The need for a strategy around obesity Adult Obesity and Diabetes in the U.S. Economic inequity, 2010 40% 100 90 35% 80 30% 70 25% 60 50 20% 40 15% 30 10% 20 5% 10 0 0% NHANES and CDC data OECD Wealth Distribution Database
Industry is far more strategic
“… Instead of imposing regressive taxes, government should work together with industry to help educate people about how to moderate their calories and achieve a balanced lifestyle... ”
Some educational messages from Coca-Cola “Each morning in the open air, take exercise to help keep fit.” - 1938
Coke’s Chief Health and Science Officer: “Akin to a political campaign, we will develop, deploy and evolve a powerful and multi- faceted strategy to counter radical organizations and their proponents.” 2015
Big Soda Lobbying and Ballot Spending, 2009-2016 Center for Science in the Public Interest.
What’s our long game?
Learning from public health successes in the U.S. Control of infectious diseases Widespread vaccination Reductions in smoking Motor-vehicle safety
Ingredients of success for public health programs Highly credible scientific evidence Laws and regulations Isaacs SL & Schroeder SA. The American Prospect, 2001.
Passage of Sugared Beverage Taxes Pre-2009 Pre-2009 World map by www.freeworldmaps.net
Passage of Sugared Beverage Taxes 2011 Pre-2009 2011
Passage of Sugared Beverage Taxes 2012 Pre-2009 2011 2012
Passage of Sugared Beverage Taxes 2013 Pre-2009 2011 2012 2013
Passage of Sugared Beverage Taxes 2014 Pre-2009 2011 2012 2013 2014
Passage of Sugared Beverage Taxes 2015 Pre-2009 2011 2012 2013 2014 2015
Passage of Sugared Beverage Taxes 2016 Pre-2009 2011 2012 2013 2014 2015 2016
Passage of Sugared Beverage Taxes 2017 Pre-2009 2011 2012 2013 2014 2015 2016 2017
Passage of Sugared Beverage Taxes 2018 Pre-2009 2011 2012 2013 2014 2015 2016 2017 2018
Berkeley – First city to pass a tax in the U.S.
How SSB excise taxes work Click to edit Master title style Click to edit Master subtitle style
Presumed mechanism of SSB excise taxes TAX PASS-THROUGH Consumer Dis istr tributors Ret etaile ilers Sh Shelf elf P Price Beha havior ors $1.62 $1.50 $1.62 Pay tax & Raise Buy fewer Consume raise price prices for SSBs fewer for retailers consumers SSBs
Presumed mechanism of SSB excise tax TAX PASS-THROUGH Consumer Dis istr tributors Ret etaile ilers Sh Shelf elf P Price Beha havior ors $1.62 $1.50 $1.62 Impr proved d public lic h health ealth
Evidence on SSB taxes Click to edit Master title style Click to edit Master subtitle style
Presumed mechanism of SSB excise tax TAX PASS-THROUGH Consumer Dis istr tributors Ret etaile ilers Sh Shelf elf P Price Beha havior ors $1.62 $1.50 $1.62 Impr proved d public lic h health ealth
Range of tax pass through Mexico Berkeley Philadelphia Oakland San Francisco 0% 50% 100% 150% 200% 250% Colchero A et al. PLoS One, 2015. Silver L et al. PLoS One, 2017. Cawley J et al. JAMA , 2018. Roberto C et al. JAMA , 2019. Falbe et al. Forthcoming
Presumed mechanism of SSB excise tax TAX PASS-THROUGH Consumer Dis istr tributors Ret etaile ilers Sh Shelf elf P Price Beha havior ors $1.62 $1.50 $1.62 Impr proved d public lic h health ealth
Relative reduction in sales of SSBs Mexico Berkeley Philadelphia Oakland -60% -50% -40% -30% -20% -10% 0% Colchero A et al. Health Affairs, 2017. Silver L et al. PLoS One, 2017. Roberto C et al. JAMA , 2019. White J et al. Forthcoming.
Presumed mechanism of SSB excise tax TAX PASS-THROUGH Consumer Dis istr tributors Ret etaile ilers Sh Shelf elf P Price Beha havior ors $1.62 $1.50 $1.62 Impr proved d public lic h health ealth
Berkeley Oakland/San Francisco Total SSBs Mean change in -52% p < 0.001 0% consumption in -54% low-income Regular p = 0.001 5% soda neighborhoods v -60% Sports over first 3 years 17% p = 0.001 b drinks of Berkeley’s tax Energy -51% -18% drinks Fruit -36% -9% drinks Sweetened -70% p = 0.001 -13% coffee/tea 29% p = 0.003 Water 4% Lee et al. AJPH , 2019. 32
SSB consumption 1-year results from Berkeley showed no decline in consumption 2-month results from Philadelphia suggest 26% decline in consumption Silver L. PLoS One, 2017. Zhong Y et al. Am J Prev Med, 2018.
Presumed mechanism of SSB excise tax TAX PASS-THROUGH Consumer Dis istr tributors Ret etaile ilers Shelf Sh elf P Price Beha havior ors $1.62 $1.50 $1.62 Cross-border shopping Impr proved d public lic h health ealth
Cross-border shopping Within Philadelphia, -1.261 billion ounces In bordering zip codes, +0.308 billion ounces Estimate 25% of SSB reduction in Philly offset by cross-border shopping Roberto C et al. JAMA , 2019.
Cross-border shopping
Geography of taxes and equity Interviews with over 100 randomly selected retailers in San Francisco, Oakland and Berkeley 53% support a statewide tax Population health benefits Equity for businesses
Presumed mechanism of SSB excise tax TAX PASS-THROUGH Consumer Dis istr tributors Ret etaile ilers Sh Shelf elf P Price Beha havior ors $1.62 $1.50 $1.62 Cross-border Substitution shopping Impr proved d public lic h health ealth
Expected overall economic impacts Robust economic research: no overall loss of jobs due to tobacco taxes No effect on jobs or economy in Mexico after 2 years No effect on employment in Philadelphia Expected to save $ in health care Guerrero-López CM et al. Prev Med, 2017. Lawman HG et al. PLoS One, 2019. Chaloupka F et al. Annu Rev Public Health , 2019.
Revisiting strategy Click to edit Master title style Click to edit Master subtitle style
What we know about SSB excise taxes Distributors internalize societal costs of their products Tax is passed through to higher shelf prices People buy fewer sugar-sweetened beverages No overall loss of jobs Revenues can create greater health equity (up next!!)
Preemption – the next fight California’s ban “Alternatives” to excise taxes Education Sales taxes…
Presumed mechanism of SSB excise taxes TAX PASS-THROUGH Consumer er Dis istr tributors Ret etaile ilers Sh Shelf elf P Price Beha havior ors $1.62 $1.50 $1.62 Impr proved d public lic h health ealth
sales Presumed mechanism of SSB excise taxes TAX PASS-THROUGH Consumer er Dis istr tributors Ret etaile ilers Shelf Sh elf P Price Beha havior ors ? Important points about sales taxes: $1.62 1. Generally smaller than excise taxes $1.50 2. Small to no impact on behaviors $1.62 3. Paid directly by consumers ? Impr proved d public lic h health ealth
Be willing to take action!!
Thank you Ana Ibarra-Castro All of our wonderful students and Ben King volunteers! Christina Becker San Francisco Department of Hannah Thompson Public Health Jen Falbe City of Berkeley Jenny Linchey Julián Ponce Johns Hopkins Global Obesity Karen Sokal-Gutierrez Prevention Center Matt Lee The California Endowment Nadia Rojas Natalya Goode NIH/NHLBI Somanette Rivas Tara Benesch 46
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