Other Points of View
Taxing “Sin Foods” — Obesity Prevention and Public Health Policy
N Engl J Med 2009; 361:e113December 10, 2009
- Article
As the United States struggles to combat obesity, some health policy experts have asserted that a tax on sugar-sweetened beverages such as soda would lead to reduced consumption of sodas and increased consumption of more healthful beverages — and thus to healthier weights and important reductions in obesity-related health care costs.1 Although we find these assertions unwarranted, we would defend such a measure as an equitable way of tackling the obesity epidemic.
Why wouldn't a soda tax decrease obesity rates by shifting consumption patterns toward healthier beverages? This is because price elasticity can refer to “own-elasticity” — changes in the patterns of consumption of a commodity in response to changes in its own price — or to “cross-elasticity” — changes in consumption of a commodity in response to changes in the price of another commodity. When it comes to sugar-sweetened beverages, there seems to be some evidence of the former,1 yet no evidence of the latter. Moreover, even if there were cross-elasticity between sodas and more healthful drinks, many beverages that are considered to be “healthy” and that therefore would not be taxed, such as Odwalla smoothies, have as many calories (or more) as an equivalent amount of sugar-sweetened cola.
In addition, although there is no question that spending in obesity-related conditions has increased over the past decade, the critical causes of skyrocketing U.S. health care costs generally — the administrative overhead of a for-profit system2 and the limited market power of health care consumers3 — are logically and empirically unrelated to obesity and would be unlikely to change even if obesity rates decreased dramatically.
So what should be done? Obesity thrives in low-income communities where the quality of food and built environments is poor. Interventions that have been shown to improve those environments include subsidies to farmers' markets and more healthful school lunches, as well as investments in the creation of bicycling and walking trails.4 If taxes on sodas or similar foods were delinked from the presumed effects of these taxes on obesity or health care costs — effects that manufacturers may well dispute — they could instead be implemented on the stronger grounds that these foods impose societal costs,5 so those who profit from them should repay society by investing in the populations most affected by obesity. We believe that a revenue-generating approach that redirects “sin taxes” toward improving the food and built environments of low-income populations has the greatest potential both to lead to healthier food choices overall and to reduce disparities in obesity rates.
Claudia Chaufan, M.D., Ph.D.
Gee Hee Hong, B.A.
Patrick Fox, M.S.W., Ph.D.
University of California San Francisco, San Francisco, CADr. Chaufan reports serving as the vice-president of California Physicians Alliance (the California branch of Physicians for a National Health Program), serving on the editorial board of Social Medicine, and being a member of the American Diabetes Association and the American Sociological Association. Dr. Fox reports receiving grant support from the California Department of Public Health. No other potential conflict of interest relevant to this article was reported.
This article (10.1056/NEJMopv0909847) was published on November 25, 2009, at NEJM.org.
- References
References
1
Brownell KD ,Frieden TR . Ounces of prevention -- the public policy case for taxes on sugared beverages. N Engl J Med 2009;360:1805-1808
Full Text | Web of Science | Medline2
Woolhandler S ,Campbell T ,Himmelstein DU . Costs of health care administration in the United States and Canada. N Engl J Med 2003;349:768-775
Full Text | Web of Science | Medline3
Anderson GF ,Reinhardt UE ,Hussey PS ,Petrosyan V . It's the Prices, stupid: why the United States is so different from other countries. Health Aff (Millwood) 2003;22:89-105
CrossRef | Web of Science | Medline4
Chaufan C, Hong GH, Fox P. Economic perspectives on public health policies to reduce obesity in California — commissioned by the California Department of Public Health 2009:1-90 (unpublished).
5
Cawley J . Markets and childhood obesity policy. Child Obes 2006;16:69-88
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