Combined fiscal policies to promote healthier diets: Effects on purchases and consumer welfare

Autoři: Juan Carlos Caro aff001;  Pourya Valizadeh aff002;  Alejandrina Correa aff003;  Andres Silva aff004;  Shu Wen Ng aff002
Působiště autorů: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America aff001;  Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America aff002;  Department of Economics, Universidad de Chile, Santiago, Chile aff003;  Department of Economics, Government and Communication, Universidad Central de Chile, Santiago, Chile aff004;  Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226731


Taxes on unhealthy foods and sweetened beverages, as well as subsidies to healthy foods, have become increasingly popular strategies to curb obesity and related non-communicable diseases. The existing evidence on the welfare effects of such fiscal policies is mixed and almost uniquely focused on tax schemes. Using the 2016-2017 Chilean Household Budget Survey, we estimate a censored Exact Affine Stone Index (EASI) incomplete demand system and simulate changes in purchases, tax incidence, and consumer welfare of three different policy scenarios: (1) a 5 percentage point additional tax on sweetened beverages (currently taxed at 18%) and a new 18% tax on sweets and snacks, (2) a healthy subsidy by zero-rating fruits and vegetables from the current 19% value-added tax, and (3) a combined (tax plus subsidy) policy. Under full pass-through of these policies, the combined scheme captures the incentives to switch purchases from both single-policy alternatives, resulting in a net welfare gain and subsidy transfer for the average Chilean household. In terms of welfare, low-income households strictly benefit from a combined policy, while high-income households experience a small consumer welfare loss, resulting in re-distributional effects.

Klíčová slova:

Beverages – Fiscal policy – Food consumption – Health care policy – Obesity – Socioeconomic aspects of health – Taxes – Vegetables


1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. The Lancet. 384(9945):766–781. doi: 10.1016/S0140-6736(14)60460-8

2. Organisation for Economic Co-operation and Development. (2017) Obesity Update 2017.

3. Malik VS, Popkin BM, Bray GA, Després JP, Hu FB. (2010) Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 121(11):1356–1364. doi: 10.1161/CIRCULATIONAHA.109.876185 20308626

4. Stanhope KL. (2012) Role of fructose-containing sugars in the epidemics of obesity and metabolic syndrome. Annual Review of Medicine 63:329–343. doi: 10.1146/annurev-med-042010-113026 22034869

5. World Cancer Research Fund International. (2018) Lessons on implementing a robust sugar sweetened beverage tax. Building Momentum.

6. Batis C, Rivera JA, Popkin BM, Taillie LS. (2016) First-year evaluation of Mexico’s tax on nonessential energy-dense foods: an observational study. PLoS Medicine 13(7):e1002057. doi: 10.1371/journal.pmed.1002057 27379797

7. Smed S. and Dejgaard Jensen J. (2005) Food safety information and food demand. British Food Journal 107(3):173–186. doi: 10.1108/00070700510586498

8. Strnad J. (2004) Conceptualizing the fat tax: the role of food taxes in developed economies. S Cal L Rev. 78:1221.

9. Bíró A. (2015) Did the junk food tax make the Hungarians eat healthier? Food Policy 54:107–115. doi: 10.1016/j.foodpol.2015.05.003

10. World Health Organization and others (2016) Fiscal policies for diet and prevention of noncommunicable diseases: technical meeting report, 5-6 May 2015, Geneva, Switzerland World Health Organization.

11. Anand SS, Hawkes C, De Souza RJ, Mente A, Dehghan M, Nugent R, et al. (2015) Food consumption and its impact on cardiovascular disease: importance of solutions focused on the globalized food system: a report from the workshop convened by the World Heart Federation. Journal of the American College of Cardiology 66(14):1590–1614. doi: 10.1016/j.jacc.2015.07.050 26429085

12. Andreyeva T, Long MW, Brownell KD. (2010) The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. American Journal of Public Health 100(2):216–222. doi: 10.2105/AJPH.2008.151415 20019319

13. Smed S, Jensen JD, Denver S. (2005) Differentiated food taxes as a tool in health and nutrition policy.

14. Nnoaham KE, Sacks G, Rayner M, Mytton O, Gray A. (2009) Modelling income group differences in the health and economic impacts of targeted food taxes and subsidies. International Journal of Epidemiology 38(5):1324–1333. doi: 10.1093/ije/dyp214 19483200

15. Zhen C, Finkelstein EA, Nonnemaker JM, Karns SA, Todd JE. (2013) Predicting the effects of sugar-sweetened beverage taxes on food and beverage demand in a large demand system. American Journal of Agricultural Economics 96(1):1–25. doi: 10.1093/ajae/aat049

16. Allais O, Etilé F, Lecocq S. (2015) Mandatory labels, taxes and market forces: An empirical evaluation of fat policies. Journal of Health Economics 43:27–44. doi: 10.1016/j.jhealeco.2015.06.003 26164818

17. Madden D. (2015) The poverty effects of a ‘fat-tax’ in Ireland. Health Economics 24(1):104–121. doi: 10.1002/hec.3006 24132985

18. Thiele S. (2010) Fat tax: A political measure to reduce overweight. In: The Case Of Germany. 115th Joint EAAE/AAEA Seminar: 0–14.

19. Sassi F, Belloni A, Mirelman AJ, Suhrcke M, Thomas A, Salti N, et al. (2018) Equity impacts of price policies to promote healthy behaviours. The Lancet 391(10134):2059–2070. doi: 10.1016/S0140-6736(18)30531-2

20. Powell LM, Chriqui JF, Khan T, Wada R, Chaloupka FJ. (2013) Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obesity Reviews 14(2):110–128. doi: 10.1111/obr.12002 23174017

21. Thow AM, Downs S, Jan S. (2014) A systematic review of the effectiveness of food taxes and subsidies to improve diets: understanding the recent evidence. Nutrition Reviews 72(9):551–565. doi: 10.1111/nure.12123 25091552

22. Härkänen T, Kotakorpi K, Pietinen P, Pirttilä J, Reinivuo H, Suoniemi I. (2014) The welfare effects of health-based food tax policy. Food Policy 49:196–206. doi: 10.1016/j.foodpol.2014.07.001

23. Tiffin R, Arnoult M. (2011) The public health impacts of a fat tax. European Journal of Clinical Nutrition 65(4):427–433. doi: 10.1038/ejcn.2010.281 21245880

24. Ministerio_de_Salud. (2017) Encuesta Nacional de Salud 2016-2017 Primeros Resultados. Gobierno de Chile. Available from: http://wwwminsalcl/wp-content/uploads/2017/11/ENS-2016-17_PRIMEROS-RESULTADOSpdf. p. 1–61.

25. Corvalán C, Reyes M, Garmendia ML, Uauy R. (2013) Structural responses to the obesity and non-communicable diseases epidemic: the Chilean Law of Food Labeling and Advertising. Obesity Reviews 14:79–87. doi: 10.1111/obr.12099 24102671

26. Lewbel A, Pendakur K. (2009) Tricks with Hicks: The EASI demand system. American Economic Review 99(3):827–863. doi: 10.1257/aer.99.3.827

27. Griffith R, Lührmann M, O’Connell M, Smith K. (2016) Using taxation to reduce sugar consumption. Institute for Fiscal Studies.

28. Brownell KD, Farley T, Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, et al. (2009) The public health and economic benefits of taxing sugar-sweetened beverages.

29. Seuring T, Archangelidi O, Suhrcke M. (2015) The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics. 33(8):811–831. doi: 10.1007/s40273-015-0268-9 25787932

30. Finkelstein E, Brown D, Popkin B. (2007) Lifetime medical costs associated with obesity and smoking. Chapel Hill.

31. Finkelstein E, Fiebelkorn IC, Wang G. (2005) The costs of obesity among full-time employees. American Journal of Health Promotion. 20(1):45–51. doi: 10.4278/0890-1171-20.1.45 16171161

32. O’Donoghue T, Rabin M. (2006) Optimal sin taxes. Journal of Public Economics. 90(10-11):1825–1849. doi: 10.1016/j.jpubeco.2006.03.001

33. Hawkes C, Smith TG, Jewell J, Wardle J, Hammond RA, Friel S, et al. (2015) Smart food policies for obesity prevention. The Lancet 385(9985):2410–2421. doi: 10.1016/S0140-6736(14)61745-1

34. Capacci S, Mazzocchi M. (2011) Five-a-day, a price to pay: an evaluation of the UK program impact accounting for market forces. Journal of Health Economics 30(1):87–98. doi: 10.1016/j.jhealeco.2010.10.006 21129797

35. Hawkes C, Alderman H, Chaloupka F, Harrison J, Kumanyika S, Smed S, et al. (2017) Principles behind evaluations of national food and beverage taxes and other regulatory efforts. Obesity Reviews 18(11):1374–1375. doi: 10.1111/obr.12594 28925079

36. Yaniv G, Rosin O, Tobol Y. (2009) Junk-food, home cooking, physical activity and obesity: The effect of the fat tax and the thin subsidy. Journal of Public Economics 93(5-6):823–830. doi: 10.1016/j.jpubeco.2009.02.004

37. Lusk JL, Schroeter C. (2012) When do fat taxes increase consumer welfare? Health Economics 21(11):1367–1374. doi: 10.1002/hec.1789 21887810

38. Miao Z, Beghin JC, Jensen HH. (2013) Accounting for product substitution in the analysis of food taxes targeting obesity. Health Economics. 22(11):1318–1343. doi: 10.1002/hec.2885 23192837

39. Harding M, Lovenheim M. (2017) The effect of prices on nutrition: comparing the impact of product-and nutrient-specific taxes. Journal of Health Economics 53:53–71. doi: 10.1016/j.jhealeco.2017.02.003 28288356

40. Chouinard HH, Davis DE, LaFrance JT, Perloff JM. (2007) Fat taxes: big money for small change. In: Forum for Health Economics & Policy 10(2).

41. Etilé F, Sharma A. (2015) Do High Consumers of Sugar-Sweetened Beverages Respond Differently to Price Changes? A Finite Mixture IV-Tobit Approach. Health Economics 24(9):1147–1163. doi: 10.1002/hec.3157 25676493

42. Colchero MA, Molina M, Guerrero-López CM. (2017) After Mexico implemented a tax, purchases of sugar-sweetened beverages decreased and water increased: difference by place of residence, household composition, and income level. The Journal of Nutrition 147(8):1552–1557. doi: 10.3945/jn.117.251892 28615377

43. Muller L, Lacroix A, Lusk JL, Ruffieux B. (2017) Distributional impacts of fat taxes and thin subsidies. The Economic Journal 127(604):2066–2092. doi: 10.1111/ecoj.12357

44. Caro JC, Ng SW, Taillie LS, Popkin BM. (2017) Designing a tax to discourage unhealthy food and beverage purchases: The case of Chile. Food Policy 71:86–100. doi: 10.1016/j.foodpol.2017.08.001 29375180

45. Instituto Nacional de Estadisticas (2018) 8va Encuesta de Presupuestos Familiares. Instituto Nacional de Estadisticas. 2016-17; Available from:

46. LaFrance JT, Hanemann WM. (1989) The dual structure of incomplete demand systems American Journal of Agricultural Economics 71(2):262–274. doi: 10.2307/1241583

47. Hanemann M, Morey E. (1992) Separability, partial demand systems, and consumer’s surplus measures Journal of Environmental Economics and Management 22(3):241–258. doi: 10.1016/0095-0696(92)90031-Q

48. Gorman WM. (1981) Some Engel Curves. In: Deaton A., Ed., Essays in the Theory and Measurement of Consumer Behaviour: In Honour of Sir Richard Stone, Cambridge University Press, Cambridge, 7–30.

49. Deaton A. (1988) Quality, quantity, and spatial variation of price The American Economic Review 418–430.

50. Cox TL, Wohlgenant MK. (1986) Prices and quality effects in cross-sectional demand analysis American Journal of Agricultural Economics 68(4):908–919. doi: 10.2307/1242137

51. Finkelstein EA, Zhen C, Bilger M, Nonnemaker J, Farooqui AM, Todd JE. (2013) Implications of a sugar-sweetened beverage (SSB) tax when substitutions to non-beverage items are considered Journal of Health Economics 32(1):219–239. doi: 10.1016/j.jhealeco.2012.10.005 23202266

52. Valizadeh P, Ng SW. (2019) Implications of food and beverage taxes and subsidies when heterogeneous responses to prices are considered Building Momentum: Lessons on Implementing a Robust Sugar Sweetened Beverage Tax

53. Zhen C and Wohlgenant MK, Karns S, Kaufman P. (2011) Habit formation and demand for sugar-sweetened beverages American Journal of Agricultural Economics 93(1):175–193. doi: 10.1093/ajae/aaq155

54. Heien D, Wesseils CR. (1990) Demand systems estimation with microdata: a censored regression approach. Journal of Business & Economic Statistics 8(3):365–371. doi: 10.1080/07350015.1990.10509807

55. Pendakur K. (2009) Chapter 7 EASI Made Easier. In: Quantifying Consumer Preferences. Emerald Group Publishing Limited 179–206.

56. Lewbel A, Pendakur K. (2006) Equivalence scales. Entry for the New Palgrave Dictionary of Economics. 2nd Edition, mimeo, Department of Economics, Boston College.

57. Colchero MA, Salgado J, Unar-Munguia M, Hernandez-Avila M, Rivera-Dommarco J. (2015) Price elasticity of the demand for sugar sweetened beverages and soft drinks in Mexico. Economics & Human Biology 19:129–137. doi: 10.1016/j.ehb.2015.08.007

58. van Oordt M. (2018) Zero-rating versus Cash Transfers under the VAT. Fiscal Studies 39(3):489–515. doi: 10.1111/1475-5890.12168

59. Politi RB, Mattos E. (2011) Ad-valorem tax incidence and after-tax price adjustments: evidence from Brazilian basic basket food Canadian Journal of Economics/Revue canadienne d’économique 44(4):1438–1470. doi: 10.1111/j.1540-5982.2011.01680.x

60. Benzarti Y, Carloni D, Harju J, Kosonen T. (2017) What goes up may not come down: asymmetric incidence of value-added taxes. National Bureau of Economic Research.

61. Bertail P, Caillavet F. (2008) Fruit and vegetable consumption patterns: a segmentation approach. American Journal of Agricultural Economics 90(3):827–842. doi: 10.1111/j.1467-8276.2008.01138.x

62. Caro, J. Carlos (2019) Child development and obesity prevention: evidence from the Chilean School Meals Program Southern Economics Association Annual Conference, Fort Lauderdale, USA.

63. Caillavet F, Fadhuile A, Nichèle V. (2016) Taxing animal-based foods for sustainability: environmental, nutritional and social perspectives in France. European Review of Agricultural Economics 43(4):537–560. doi: 10.1093/erae/jbv041

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