One of the most effective ways to decrease the harms of smoking is by increasing the cost of cigarettes through tobacco taxes. Indeed, an increase in the cost of cigarettes by only 10 percent could prevent millions of tobacco-related deaths. What about taxing unhealthy food? In general, public health decision makers have had three main options: inform through labeling, nudge with incentives, or directly intervene in markets using more heavy-handed approaches like instituting regulations or taxes.

“Policy approaches have proven crucial for other public health priorities, such as reducing tobacco use, alcohol abuse, and deaths from motor vehicle crashes.” In fact, installing air bags, for example, helped more than either “driver education alone or by labeling cars with information on crash risk.” Given that heart disease kills more than ten times more people than injuries on the road, maybe the “current epidemic of nutrition-related disease requires a similar multifaceted approach…[E]ven modest resulting dietary improvements could help reduce the burden of chronic disease significantly.” Perhaps a national system of subsidies for good foods, as well as taxes for bad ones, could “facilitate more sensible dietary choices.” Would they work? I discuss this in my video Would Taxing Unhealthy Foods Improve Public Health?.

A systematic review of the available evidence suggests such taxes and subsidies would in fact work. As I show in my video at 1:30, it seems the more unhealthy foods are taxed, the more consumption drops. Likewise, the more healthy foods like fruits and vegetables are subsidized and their prices drop, the more consumption increases. A small price difference between leaded and unleaded gasoline, for example, succeeded in decreasing our exposure to lead. What about a tax to decrease our exposure to saturated fat? As you can see from the data at 1:52 in my video, such a tax could potentially save thousands of lives.

Wouldn’t such a tax disproportionally affect the poor, though? Yes, it would benefit them the most—just like cigarette taxes. The classic tobacco industry argument is that cigarette taxes are “unfair” and “regressive,” burdening the poor the most. The public health community’s response? “Cancer is unfair” and “[c]ancer is regressive,” disproportionately burdening the poor such that a cigarette tax could result in the greatest health gains for the least well-off. The so-called Committee Against Unfair Taxes was actually just a front, “organised and funded by the tobacco industry,” one front group among many, as you can see at 2:42 in my video. This is a common tactic used by the industry to hide its role in fighting tobacco taxes, in addition to trying to overtly buy off politicians. The fact that the industry fights tooth and nail suggests that tobacco taxes can indeed affect consumption. Much of the data on food taxes and subsidies, however, have been based on models or “stated preferences” to hypothetical scenarios where people merely say they’d change consumption patterns based on prices. There hasn’t been as much real world data.

Researchers have put people through high-tech, 3D supermarket simulators, which you can see depicted at 3:15 in my video, and found that a 25 percent discount on fruits and vegetables appears to boost produce purchases by 25 percent. That’s nearly two pounds a week, but virtual fruits and veggies don’t do you any good. Does this work out in the real world? Yes. In fact, South Africa’s largest health insurance company started offering up to 25 percent cash back on healthy food purchases to hundreds of thousands of households—up to $500 USD a month. Why would the insurance company do that? Why give money away? Because it works. The healthy food cash-back program was associated with an increase in the consumption of fruits, vegetables, and whole grains, as well as a decrease in foods high in added sugar, salt, and fat, including processed meats and fast food.

Subsidies are more common than taxes, though, in Europe, where a number of countries have instituted taxes on foods that are sugary or salty. Denmark was the first to introduce a tax on saturated fat, such as meat, dairy, and eggs, but it only took the food industry about a year to squash it, demonstrating that “public health advocates are weak in tackling the issues of corporate power.”

There’s “an enormous imbalance” between the influence exerted by public health professionals compared to the political might of the food industry. It brings to mind the fight over proposed “traffic light labelling” on food in the European Union. Apparently, it was much too easy to understand, simple and straightforward, so the industry lost its mind and spent more than $1.4 billion USD killing it in favor of the confusing “daily amount” labeling guidelines that require a “bring-your-calculator-to-the-grocery-store” approach to make grocery shopping as confusing as possible, as you can see at 4:51 in my video.

Denmark ended up canceling the fat tax and shelving their sugar tax because the farming and food company interests claimed too many jobs would be lost if people ate healthier. Apparently, a healthy economy was more important than a healthy population. Ironically, it was abolished just when evidence of its effects started to appear. Researchers “conclude[d] that the introduction of the saturated fat tax contributed to reducing the intake of saturated fat among Danish consumers” from some meat and dairy products—but not from sour cream, though. The public ate so much more low-fat sour cream that it outweighed the smaller reduction in consumption of high-fat sour cream.

Indeed, we always have to think about the unintended consequences. Swapping out sugary cookies for salty chips, for example, might not do the public’s health many favors. One field study of a tax on soda found that it may drop soft drink purchases, at least in the short term, but households may just end up buying more beer.

This idea is the flip side of sorts to my video Taxpayer Subsidies for Unhealthy Foods.

For more on how the food industry has borrowed from the tobacco industry playbook, see

What about those who insist that sodium really isn’t bad for you? Check out:

And those who insist that saturated fat really isn’t bad for you? See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

What about those who insist that sugar really isn’t bad for you? Watch Big Sugar Takes on the World Health Organization and Does Diet Soda Increase Stroke Risk as Much as Regular Soda?.

In health,

Michael Greger, M.D.

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