Highlights Fully integrated Macroeconomic-Environmental-Demographic-health model. Palm oil sales tax creates dietary and health improvements. Palm oil sales tax causes temporary economic losses and adverse environment impacts. Policymakers should consider trade-offs when using fiscal food policy instruments. Fiscal food policy research should include both food and non-food policy indicators.

Objective: Palm oil is a cheap and versatile edible oil in widespread use as a food ingredient that has been linked to negative health and environmental outcomes. The current study aimed to understand the prospects for future health-focused policy development to limit food use of palm oil and promote a greater diversity of oils in Thailand's food system. Design: Eighteen semi-structured interviews were conducted with a range of stakeholders. The interviews probed views on the economic, health and environmental dimensions of the issue, the prospects for health-focused policy development and the policy development process. Transcripts were analysed using a health policy analytical framework. Setting: Thailand. Subjects: Stakeholders from a range of ministries, regulatory agencies, the private sector, non-governmental organizations and academia. Results: There are several impediments to the emergence of strong regulation, including the primacy of economic considerations in setting policy, doubt and misperception about health implications and a complex regulatory environment with little space for health-related considerations. At the same time, some sections of the food industry producing food for domestic consumption are substituting palm with other oils on the basis of consumer health perceptions. Conclusions: Strong regulation to curb the growth of palm oil is unlikely to emerge soon. However, a long-term strategy can be envisaged that relies on greater policy support for other indigenous oils, strategic rebalancing towards the use of palm oil for biofuels and oleochemicals, and harnessing Thailand's food technology capabilities to promote substitution in food production in favour of oils with healthier fatty acid composition.

Background Palm oil’s high yields, consequent low cost and highly versatile properties as a cooking oil and food ingredient have resulted in its thorough infiltration of the food sector in some countries. Longitudinal studies have associated palm oil’s high saturated fatty acid content with non-communicable disease, but neither the economic or disease burdens have been assessed previously. Methods This novel palm oil-focussed disease burden assessment employs a fully integrated health, macroeconomic and demographic Computable General Equilibrium Model for Thailand with nine regional (urban/rural) households. Nutritional changes from food consumption are endogenously translated into health (myocardial infarction (MI) and stroke) and population outcomes and are fed back into the macroeconomic model as health and caregiver-related productive labour supply effects and healthcare costs to generate holistic 2016–2035 burden estimates. Model scenarios mirror the replacement of palm cooking oil with other dietary oils and are compared with simulated total Thai health and macroeconomic burdens for MI and stroke. Results Replacing consumption of palm cooking oil with other dietary oils could reduce MI/stroke incident cases by 8280/2639 and cumulative deaths by 4683/894 over 20 years, removing approximately 0.5% of the total Thai burden of MI/stroke. This palm cooking oil replacement would reduce consumption shares of saturated/monounsaturated fatty acids in Thai household consumption by 6.5%/3% and increase polyunsaturated fatty acid consumption shares by 14%, yielding a 1.74% decrease in the population-wide total-to-HDL cholesterol ratio after 20 years. The macroeconomic burden that would be removed is US$308mn, approximately 0.44% of the total burden of MI/stroke on Thailand’s economy or 0.003% of cumulative 20-year GDP. Bangkok and Central region households benefit most from removal of disease burdens. Conclusions Simulations indicate that consumption of palm cooking oil, rather than other dietary oils, imposes a negative health burden (MI and stroke) and associated economic burden on a high consuming country, such as Thailand. Integrated sectoral model frameworks to assess these burdens are possible, and burden estimates from our simulated direct replacement of palm cooking oil indicate that using these frameworks both for broader analyses of dietary palm oil use and total burden analyses of other diseases may also be beneficial. Electronic supplementary material The online version of this article (10.1186/s12963-019-0191-y) contains supplementary material, which is available to authorized users.

United Nations (UN) member states have, since 2011, worked to address the emerging global NCD crisis, but progress has, so far, been insufficient. Food trade policy is recognised to have the potential to impact certain major diet-related health and environmental outcomes. We study the potential for using import tariff protection as a health and environmental policy instrument. Specifically, we apply a rigorous and consistent Macroeconomic-Environmental-Demographic-health (MED-health) simulation model framework to study fiscal food policy import tariffs and dietary change in Thailand over the future 20 year period 2016-2035. We find that the existing Thai tariff structure, by lowering imports, lowers agricultural Land Use Change (LUC)-related GHG emissions and protects against cholesterol-related cardiovascular disease (CVD). This confirms previous evidence that food trade, measured by import shares of food expenditures and caloric intakes, is correlated with unhealthy eating and adverse health outcomes among importing country populations. A continued drive towards tariff liberalization and economic efficiency in Thailand may therefore come at the expense of reduced health and environmental sustainability of food consumption and production systems. Due to large efficiency losses, the existing tariff structure is, however, not cost-effective as an environmental or health policy instrument. However, additional simulations confirm that stylized 30% food sector import tariffs generally improve nutritional, clinical health, demographic, and environmental indicators across the board. We also find that diet-related health improvements can go hand-in-hand with increased Saturated Fatty Acid (SFA) intakes. Despite limited cost-effectiveness, policy makers from Thailand and abroad, including WHO, would therefore be well advised to consider targeted fiscal food policy tariffs as a potential intervention to maintain combined health and environmental sustainability, and to reconsider the specification of WHO dietary guidelines with their focus on SFA intake (rather than composition of fatty acid intake) targets.

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