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Fiscal policies to promote healthy diets: WHO guideline
World Health Organization (2024)
World Health Organization - ISBN: 978-92-4-009101-6
This WHO guidance aims to meet the following objectives:
"provide evidence-based recommendations and implementation considerations on taxation of foods that do not contribute to a healthy diet and sugar-sweetened beverages (SSBs), and on a subset of subsidies on foods that contribute to a healthy diet (the subset including subsidies that have the primary intention to change consumer behaviour by lowering prices of targeted foods and beverages at retail level);
enable evidence-informed advocacy to advance policy action;
guide future research to further strengthen the evidence base for policy action; and
contribute to the creation of food environments that enable healthy dietary practices among children and adults."
The authors state:
"Affordability of food and beverages (which is a function of food and beverage price and disposable income) is a key characteristic of the food environment and is well established as an important influence on food and beverage purchases and consumption. The inverse relationship between food and beverage prices and purchases and consumption indicates that taxes can reduce, and subsidies can increase, consumption of targeted products. Accordingly, implementing fiscal policies that discourage consumption of foods that do not contribute to a healthy diet and/or encourage consumption of foods that contribute to a healthy diet has been proposed in various documents adopted by the World Health Assembly, including the Global Strategy on Diet, Physical Activity and Health; the Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition; and the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020.1"
"Recognizing the broad range of fiscal measures governments can use for health promotion, the scope of this guideline is limited to consumption taxes (e.g. excise taxes, sales taxes) on foods that do not contribute to a healthy diet and SSBs, and to a subset of subsidies on foods that contribute to a healthy diet (the subset including subsidies that have the primary intention to change consumer behaviour by lowering prices of targeted products at retail level; for example, food vouchers, discounts, reduction of value-added tax (VAT) and inclusion of food in public distribution systems)."
"This guideline is not an implementation manual. It does not describe how countries can implement and monitor fiscal policies to promote healthy diets, but rather recommends what measures to take."
"The systematic review showed large and significant effects of SSB taxes on price change of taxed beverages and purchases of taxed beverages. This large effect allowed for upgrading the certainty of the observational evidence using the GRADE methodology (see section 2.1) to moderate. Meta-analyses showed a passthrough rate – that is, the proportion of a tax that is transferred to the price paid by consumers – of 82% and that SSB taxes significantly decreased purchases of taxed beverages, with an own-price elasticity of –1.59. The own-price elasticity of –1.59 indicates that a 10% tax-induced price increase would reduce purchases of SSBs by about 16%."
"The systematic review identified far fewer eligible studies that evaluated the effect of a tax on foods or nutrients. There was very low certainty evidence on the effect of taxes on foods on price change, purchases of taxed foods and purchases of untaxed foods. There was very low certainty evidence about the effect of taxes on saturated fats on the price of taxed foods, purchases of taxed foods and purchases of untaxed foods, based on studies of one tax, which was in place for a limited duration. Evidence from modelling studies considered by the NUGAG Subgroup on Policy Actions showed that food taxes can have a large desirable effect on health-related outcomes."
"The systematic review evidence on a subset of food subsidies (the subset including subsidies that have the primary intention to change consumer behaviour by lowering prices of targeted foods at retail level) included studies on food vouchers; subsidized fruit and vegetable programmes; discounted pulses and fortified wheat flour; and a reduction in VAT on fruits and vegetables. All except one subsidy policy (the VAT reduction) targeted low-income populations. The certainty of evidence for this subset of subsidies was very low for price change, purchases of subsidized and unsubsidized foods, consumption of subsidized and unsubsidized foods and diet. However, available studies consistently showed a significant increase in purchase of subsidized fruits and vegetables."
Recommendations
Taking into consideration evidence and stakeholder input, the subsequent guidance recommends:
"WHO recommends implementation of a policy to tax sugar-sweetened beverages (SSBs). (Strong recommendation)"
"For this recommendation, ‘SSBs’ refers to all types of non-alcoholic beverages containing free sugars,1 including carbonated and non-carbonated soft drinks, fruit and vegetable juices2 and drinks, nectars, liquid and powder concentrates, flavoured waters, vitamin waters, energy and sports drinks, readyto-drink teas, ready-to-drink coffees, flavoured milks and milk-based drinks, and plant-based milk substitutes."
"This recommendation covers SSBs purchased for either adults or children."
"The regressivity of a tax on SSBs is a common argument used by opponents of such taxes (5). However, this argument is based solely on the tax burden incurred by consumers (5). It does not consider the health and economic harm caused by excessive SSB consumption, which often disproportionately affects people of lower socioeconomic status (SES), or the subsequent health benefit (and economic gains from this benefit) of a reduction in SSB consumption, which is likely to be greater among people of lower SES (5). The WHO manual on SSB taxation policies proposes additional counter-arguments to the regressivity of a tax on SSBs (5)."
"WHO suggests implementation of a policy to tax foods that do not contribute to a healthy diet. (Conditional recommendation)"
"Foods that do not contribute to a healthy diet are those that are high in saturated fatty acids, trans-fatty acids, free sugars and/or salt and/or which contain non-sugar sweeteners, and which are usually highly processed, and/or the consumption of which is associated with negative health outcomes."
"Nutrient profile models – tools for classifying foods and beverages according to their nutritional composition for reasons relating to disease prevention and health promotion – provide one means of defining foods and beverages to be taxed or subsidized. Nutrient profile models used for this purpose should align with recognized and credible national or international dietary guidelines."
"This recommendation covers foods that do not contribute to a healthy diet purchased for either adults or children."
"WHO suggests implementation of a policy to subsidize foods that contribute to a healthy diet. (Conditional recommendation)"
"Foods that contribute to a healthy diet are those that are nutrient-dense, rich in naturally occurring fibre and/or unsaturated fatty acids, low in saturated fatty acids, trans-fatty acids, free sugars and/or salt, free of non-sugar sweeteners, and/or the consumption of which is associated with positive health outcomes."
"This recommendation covers foods that contribute to a healthy diet purchased for adults and children."
"Inequities exist in nutrition status and diet-related health status, with lower-income populations bearing a disproportionate burden of disease. Subsidies may reduce such inequities."
