Political and public acceptability of a sugar-sweetened beverages tax: a mixed-method systematic review and meta-analysis

Abstract

Background Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax. Methods Four electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions. Results Thirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38–0.47) supports an SSBs tax, 39% (0.29–0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60–0.72) supports an SSBs tax if revenue is used for health initiatives. Conclusions Beliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation. Electronic supplementary material The online version of this article (10.1186/s12966-019-0843-0) contains supplementary material, which is available to authorized users.

Examining the News Media Reaction to a National Sugary Beverage Tax in South Africa: A Quantitative Content Analysis.

“…On the other hand, government o cials, academics and medical experts, and NGO representatives offered signi cantly more supporting opinions of the HPL than opposing ones. These results corroborate previous ndings that among stakeholders including industry, government, public health experts, and the public, opposition from industry is a common barrier to SSB tax implementation (38).…”

Costs, equity and acceptability of three policies to prevent obesity: A narrative review to support policy development

“…52 A systematic review of the literature concluded that public acceptability was increased if the revenue was used for beneficial purposes. 53 South Africa: cynicism that the tax is for health purposes, not government revenue. 54 United Kingdom: mistrust of the use of the revenue, and concern tax is insufficient or ineffective as a dietary intervention.…”

Nutrition Policy and Individual Struggle to Eat Healthily: The Question of Public Support

“…The results show that the greatest public acceptability of government interventions is given for the least intrusive interventions that are often the least effective. Eykelenboom et al [24] recommend four strategies to increase public acceptability of a sugar-sweetened beverage tax. First, communicate the differences between the general belief and the scientific evidence of such a tax.…”

“…Second, use the additional revenue for health initiatives. Third, tell the purpose of the tax to the consumer in a transparent way and fourth, give political priority to the problem of policy adoption and implementation [24]. Moreover, interventions that do not affect one's own behaviour are more accepted than interventions that target it [23].…”