Using nutritional survey data to inform the design of sugar-sweetened beverage taxes in low-resource contexts: a cross-sectional analysis based on data from an adult Caribbean population

Abstract

ObjectiveSugar-sweetened beverage (SSB) taxes have been implemented widely. We aimed to use a pre-existing nutritional survey data to inform SSB tax design by assessing: (1) baseline consumption of SSBs and SSB-derived free sugars, (2) the percentage of SSB-derived free sugars that would be covered by a tax and (3) the extent to which a tax would differentiate between high-sugar SSBs and low-sugar SSBs. We evaluated these three considerations using pre-existing nutritional survey data in a developing economy setting.MethodsWe used data from a nationally representative cross-sectional survey in Barbados (2012–2013, prior to SSB tax implementation). Data were available on 334 adults (25–64 years) who completed two non-consecutive 24-hour dietary recalls. We estimated the prevalence of SSB consumption and its contribution to total energy intake, overall and stratified by taxable status. We assessed the percentage of SSB-derived free sugars subject to the tax and identified the consumption-weighted sugar concentration of SSBs, stratified by taxable status.FindingsAccounting for sampling probability, 88.8% of adults (95% CI 85.1 to 92.5) reported SSB consumption, with a geometric mean of 2.4 servings/day (±2 SD, 0.6, 9.2) among SSB consumers. Sixty percent (95% CI 54.6 to 65.4) of SSB-derived free sugars would be subject to the tax. The tax did not clearly differentiate between high-sugar beverages and low-sugar beverages.ConclusionGiven high SSB consumption, targeting SSBs was a sensible strategy in this setting. A substantial percentage of free sugars from SSBs were not covered by the tax, reducing possible health benefits. The considerations proposed here may help policymakers to design more effective SSB taxes.

Comparing taxes as a percentage of sugar-sweetened beverage prices in Latin America and the Caribbean

“…For the PAHO SSB tax survey, sugar-sweetened carbonated drinks and fruit drinks – with less than 100% fruit concentration – were selected as they represent the two SSB categories with the highest market share in volume sold in LAC (no data available for most Caribbean countries). 39 , 40 Energy drinks were also selected as volume sold has tripled in the last decade and they represent an emerging public health hazard, particularly for youths. 39 , 41 The fourth and last SSB category included was sugar-sweetened milk drinks as they may promote increased free sugar and energy intake and a previous analysis found that the majority of countries in LAC do not apply excise taxes on this SSB category.…”

Evidence of a health risk ‘signalling effect’ following the introduction of a sugar-sweetened beverage tax

“…We identified the two most commonly consumed SSBs in the Barbados population: sodas and juice drinks ( Alvarado et al, 2020 ). We assessed the existence of an expressive risk signal around sodas and juice drinks separately, driven by the hypothesis that the risk signal produced by a tax may vary by product type.…”

“…The Minister of Finance cited high levels of diabetes and the need “to encourage healthier consumption patterns of our people as it relates to the consumption of sweetened beverages” as the rationale for the tax ( Sinckler, 2015 ). According to a nationally representative survey conducted between 2012 and 2013, adult SSB consumption was more than four times the global average ( Alvarado et al, 2020 ) and the prevalence of diabetes was double the global average ( Howitt et al, 2015 ).…”