A comparative policy analysis of the adoption and implementation of sugar-sweetened beverage taxes (2016–19) in 16 countries

Abstract

Taxes on sugar-sweetened beverage (SSBs) are recommended as part of comprehensive policy action to prevent diet-related non-communicable diseases (NCDs), but have been adopted by only one quarter of World Health Organization (WHO) Member States. This paper presents a comparative policy analysis of recent SSB taxes (2016–2019) in 16 countries. This study aimed to analyze the characteristics and patterns of factors influencing adoption and implementation of SSB taxes and policy learning between countries, to draw lessons for future SSB taxes. The data collection and analysis were informed by an analytical framework that drew on ‘diffusion of innovation’ and theories of policy learning. Qualitative data were collected from policy documents and media, in addition to national statistics. Qualitative data were thematically analyzed and a narrative synthesis approach was used for integrated case study analysis. We found adaptation and heterogeneity in the approaches used for SSB taxation with a majority of countries adopting excise taxes, and consistent health framing in media and policy documents. Common public frames supporting the taxes included reducing obesity/NCDs and raising revenue (government actors) and subsequent health system savings (non-government actors). Opposing frames focused on regressivity and incoherence with other economic policy (government actors) and posited that taxes have limited health benefits and negative economic impacts on the food industry (industry). Evident ‘diffusion networks’ included the WHO, predominantly in middle-income countries, and some regional economic bodies. We found indications of policy learning in the form of reference to other countries’ taxes; particularly countries with membership in the same economic bodies and with shared borders. The study suggests that adoption of SSB taxation could be enhanced through strategic engagement by health actors with the policy making process, consideration of the economic context, use of consistent health frames by cross-sector coalitions, and robust evaluation and reporting of SSB taxation.

Examining the Role and Strategies of Advocacy Coalitions in California’s Statewide Sugar-Sweetened Beverage Tax Debate (2001-2018)

“…California's statewide SSB tax policy debate and experience between 2001-2018 reveals numerous lessons that can inform future SSB tax campaigns. As prior debates about state tobacco taxes, nutrition policy, and SSB taxes passed elsewhere, 48 we found a public health coalition and industry coalition were involved in California's SSB tax policy debate.…”

Political and socioeconomic factors that shaped health taxes implementation in Peru

“…This autonomy of the MoEF, together with the stability of that institution, despite changes in leadership in the government, can be considered key factors that allowed the effective adoption and implementation of health taxes. Unlike other political processes in other countries where interministerial support was an important factor,68–70 the MoEF is, therefore, a leading actor for health taxes in Peru 71. In contrast, other ministries such as the MoH played a marginal role due to institutional weaknesses.…”

“…Peru’s alignment with a global public health agenda and the WHO FCTC has been beneficial for implementing health taxes and getting external support. The recurrent mention of ‘early adopter’ countries71 within the region, and with successful adoption of health taxes and similar sociopolitical backgrounds68 73 74 were also essential for legitimising the need for such public policy 68. More research on these processes could deepen whether, in these cases, we could be talking about policy transfer or policy diffusion networks 71 75 76…”

Pulsed light processing of low sugar, added fiber RTD mango beverage

“…It is worth mentioning that health authorities and nutrition experts often advise limiting the consumption of beverages with added sugars, including fruit juices, as they are linked to obesity, diabetes, and dental cavities (Micha et al, 2017; Pepin et al, 2019; Wan et al, 2021). Since 2017, Saudi Arabia and many countries such as Mexico, the United Kingdom, France, and Chile have implemented or considered implementing sugar taxes on sugary beverages, including fruit drinks, to address public health (Mulcahy et al, 2022).…”