Estimated effects of food taxes and subsidies on health, economics, and equity in Australia: a modelling study

Abstract:

Background

Fiscal food policies can improve diets and reduce the burden of diet-related diseases. We aimed to model the effects of various health-promoting food taxes and subsidies in Australia on health, economics, and equity.

Methods

In this modelling study, the modelled scenarios included a 20% tax on unhealthy foods (ie, sugar-sweetened beverages, confectionery, snack foods, biscuits, pastries, ice cream, and processed meat), a 20% subsidy for fruits and vegetables, and a 20% tax on unhealthy foods earmarked to subsidise fruits and vegetables. We used a food demand system and nationally representative dietary intake data from the National Nutrition and Physical Activity Survey to estimate changes in energy, sodium, fruit, and vegetable intake for each policy across 5-year age–sex–socioeconomic status groups. These changes were input into a multiple-cohort proportional multistate lifetable model to estimate premature deaths averted, gains in health-adjusted life-years (HALYs), and health-care cost savings over the lifetime of the 2019 Australian adult population. Analyses were stratified by food category and socioeconomic quintile.

Findings

We estimated that a 20% tax on unhealthy foods could avert 212 000 (95% uncertainty interval 196 000–229 000) premature deaths, generate 1370 000 (1270 000–1480 000) HALYs, lower health-care costs by AU$14·9 billion (4·6–27·5), and promote health equity. The estimated HALYs gained could be approximately 7 times greater than by taxing sugar-sweetened beverages alone. Conversely, a 20% subsidy for fruits and vegetables could avert 44 000 (36 000–52 000) premature deaths and generate 203 000 (155 000–249 000) HALYs, but might not lead to meaningful changes in health-care costs. Furthermore, earmarking the 20% tax to fund subsidies for fruits and vegetables could offset some of the financial burden of the tax.

Interpretation

Fiscal food policies could be powerful levers to promote health and equity in Australia and should be considered by policy makers.