- 1 Key messages and recommendations
- 2 Background
- 3 Introduction
- 4 Public discussion on food taxes
- 5 Policy context for a food tax
- 6 Issues associated with designing a food tax
- 7 Objectives of a potential food tax in Australia
- 8 Subsidies
- 9 Potential for a food tax in relation to other obesity control measures
- 10 Conclusions
- 11 Priorities for future research relating to food taxes
- 12 Position statement details
- 13 References
Key messages and recommendations
There is little Australian evidence regarding the impact of food taxes on dietary behaviours and health outcomes. Internationally, some studies have shown food taxes to affect positive changes in dietary behaviours and potentially influence health outcomes although the consistency and strength of the evidence is limited. There is a need for further research to clarify the impact of a food tax on Australian consumer behaviour, rates of overweight and obesity, and cancer risk, as part of a cost-effective, sustainable, multi-strategy approach.
Low income groups have a greater burden of diet-related chronic disease than people from higher socio-economic levels. A food tax is likely to be regressive for low income households. However the experience with tobacco taxes has been that those on low incomes are more responsive to price increases on tobacco products. Therefore if the same is true for food products, lower income households could potentially benefit more from a food tax. Additionally, incorporating subsidies (e.g. for fresh fruit and vegetables) into a tax design to support those on low incomes may help to combat the impact of a tax on unhealthy foods and may result in higher consumption of healthier foods such as fruit and vegetables.
A small tax on a range of food products or a single category of food that is commonly consumed (e.g. sugar sweetened beverages) is likely to raise high levels of revenue that could either be used for general revenue, hypothecated for use in health promotion, to off-set the cost of subsidising healthy foods either for the wider population or for those on low incomes, or all of these uses. Public health advocates argue that hypothecation to support health promotion should be part of the policy solution.
Prior to recommendations regarding a food tax, Cancer Council recommends that the following evidence gaps in Australia should be considered:
Cancer Council Australia recommends that the federal Depart of Treasury and Finance investigate potential tax options to increase the price of sugar-sweetened beverages that offer no nutritional benefits, with the aim of changing purchasing habits and achieving healthier diets.
Currently 63% of Australian adults are overweight or obese and around one in four Australian children are overweight or obese. As obesity is a modifiable risk factor for cancer, it is important that a range of appropriate policies and strategies to promote healthy eating and reduce overweight and obesity are implemented within the community.
Food taxes have been proposed or introduced in a number of countries as part of efforts to improve diets, address rising rates of obesity and reduce diet-related chronic disease. This position statement assesses the evidence relating to the effectiveness of food taxes and subsidies to improve public health in Australia and overseas.
Overweight and obesity are risk factors for cancer as well as many other chronic diseases such as cardiovascular disease and type 2 diabetes. There is convincing evidence that overweight and obesity increase the risk of cancers of the bowel, kidney, pancreas, oesophagus, endometrium and breast (in post-menopausal women). Weight gain results from the over-consumption of energy dense, nutrient poor foods and lack of physical activity. The consumption of sugar-sweetened beverages is associated with increased energy intake and in turn, weight gain and obesity. In 2008, the total cost of obesity in Australia was estimated at more than $58 billion. In addition dietary factors contribute to some types of cancer, and ensuring an adequate intake of fruit and vegetables is protective against some types of cancer.
In 2009, the National Preventative Health Taskforce recommended, as part of a comprehensive approach to the problem, that a review of economic policies and taxation systems be undertaken. More specifically the Taskforce recommended that methods for using taxation, grants, pricing, incentives and/or subsidies to promote production, access to and consumption of healthier foods be developed.
There are a number of complex issues associated with food taxes relating not only to the evidence that a food tax can change purchasing behaviour and impact on health outcomes, but also on the intricacies associated with the design of a food tax.
This position statement outlines the role and impact of food taxes and subsidies and the potential implications for consumption, dietary behaviour, obesity and cancer risk. It is based on a comprehensive review of the international and Australian literature relating to food taxes and subsidies.
Public discussion on food taxes
The discussion in Australia regarding food taxes has been influenced by a number of prominent reports that suggest a food tax would be an effective policy measure to reduce the health and financial costs associated with obesity. Opponents of a food tax argue that a food tax reduces personal responsibility to make healthier choices and that government shouldn’t restrict an individual’s right to make healthy or unhealthy choices. Those opposed also argue that taxes should only be used to address the externalities such as social and health costs, but should not penalise appropriate users, such as those who are not overweight. In response to the National Preventative Health Taskforce Report, the Commonwealth Government referred to the Henry Review of Australia’s Future Tax System, which did not specifically recommend the introduction of a food tax, and stated that it did not intend to commission a further review of economic policy and tax systems at that time. However, the Goods and Services Tax was specifically excluded from the Henry Tax Review and, as a result, taxes on food were not considered or reviewed by this panel.
Policy context for a food tax
In addition to the political debate, there are two policy experiences from within Australia, as well as the food tax experiences from overseas that add important context.
The Australian context
Australia currently has a range of taxes on tobacco and alcohol recognising the health and social costs imposed by consumption of these products, and in effect also places an impost on some unhealthy foods and pre-prepared foods through the Goods and Services Tax while most healthy foods and unprocessed foods are exempt. However, it should be noted that in some cases the amount of GST imposed was lower than some taxes already in place, so for example the wholesale sales tax on sugar sweetened drinks reduced from 20% to a Goods and Services Tax of 10%. While there has been considerable analysis of the impacts of alcohol and tobacco taxation (with results showing significant declines in consumption with a real increase in the price of these products), the implications of the GST on influencing food consumption remains largely unexplored.
Table 1 outlines those foods that are taxed and those that are exempt from GST. The exclusion of basic foods from the GST was a key factor in the successful passage of the GST legislation through the Parliament in 2000. Specifically basic foods were originally excluded from the GST on equity grounds, as expenditure on food represents a higher proportion of income for those on low incomes compared to those on high incomes.
Table 1. GST-free and taxable foods in Australia
|GST-free food||Taxable food|
Source: Australian Taxation Office, 2010
International approaches to food taxes
Food taxes have been introduced or proposed in a number of countries as a way of influencing purchasing behaviour to address obesity and other chronic diseases and/or to raise revenue.
Several countries are currently taking steps to introduce a food tax, with some applied on a food category basis and some applied according to the nutrient content of the foods. Hungary has implemented a tax on foods with high fat, sugar, and salt content. Denmark introduced a tax on saturated fat in 2011, but abolished it in 2012. In 2012 France introduced a tax on sugar and artificially sweetened beverages and Finland has proposed to increase the tax on high-sugar products including beverages, ice-cream and confectionery. In the Pacific region, Nauru and French Polynesia introduced taxes to raise revenue for health promotion purposes. Nauru has a ‘sugar levy’ of 30% on imported sugar, confectionery and sugary drinks; while French Polynesia has introduced a production tax and consumption tax on a range of ‘unhealthy’ foods such as sweetened drinks, confectionery and ice creams. There is public discussion regarding the introduction of a tax on food in a number of other countries, including Romania, Taiwan, Sweden, Norway and the UK.
A number of states in the US currently tax soft drinks and snack foods and although these taxes are primarily targeted at raising revenue, their effectiveness in reducing obesity has been investigated. A 2010 study by Sturm et al. reports that the small taxes in place currently are unlikely to have measurable effects on soft drink consumption or obesity among children overall. Sturm et al also point out that extrapolating their finding of a small marginal effect (-0.013 BMI units) to a larger tax of 18% would produce a 20% reduction in BMI gain, which is a greater effect than any other intervention has demonstrated to date. Studies from the same year by Fletcher et al. further suggest that although these soft drink taxes do influence consumption, the behavioural changes are not sizeable enough to lead to significant changes in population weight. Additionally, two studies indicate that there is little difference in obesity between states with a soft drink tax and states without a soft drink tax. Some public health and economic experts consider that in order to produce significant outcomes for weight, the level of the soft drink tax would have to be raised substantially.
Study methodology is a key issue in relation to the relevance of the evidence for a food tax to influence weight and health outcomes, and therefore relevance to public health policy. The main limitations of the studies described in the previous section are that they use population body weight to measure outcomes (which is affected by other factors), and the studies make no direct link between price changes and purchase of the taxed item, i.e. it is not known whether the taxes are even passed onto consumers.
A greater understanding of the impact of these policies, as well as the similarities and differences would help to inform the development of food tax policy in Australia.
Issues associated with designing a food tax
As illustrated in Figure 1, there are number of issues associated with designing a food tax. One of the guiding principles will be the intended policy objectives, with the design likely to change depending on whether it is seeking to change consumption patterns, influence chronic disease outcomes, decrease overweight and obesity, or raise revenue for government. For example, a number of studies indicate that in order to change behaviour, a tax would have to be of substantial size, while if the aim is to raise revenue, even a small tax on a single category of product that is commonly consumed (e.g. soft drink) could be effective. The purpose of the tax will also influence the taxation mechanism to be used (e.g. a levy or excise tax on retail price or volume) and whether it may be implemented at the federal or state level. Furthermore, introducing a tax, subsidy, or a combination of both will result in different behavioural and equity implications for consumers and fiscal implications for governments.
Determining which foods will be taxed (or subsidised) is a complex decision that would require a balancing of issues such as administrative complexity, with how closely the tax is able to target those foods that contribute most to weight gain and high body mass. The literature predominantly discusses foods being taxed on either a food category basis (such as soft drinks, chips, take away foods) or a on a single nutrient (such as saturated fat) or on an overall analysis of nutritional value using nutrient profiling.
Figure 1. Food tax design issues
Cross-elasticity of demand
Other tax design issues include the point in the food system where it might be applied (e.g. retail, manufacturing) and any positive cross-elasticity of demand, that is any increase in demand for non-taxed products (that are energy dense and nutrient poor) following an increase in price for taxed products. For example, if a tax on soft drink influenced consumers to switch to other sugary or high fat beverages, the net effect on energy intake (and in turn overweight, obesity and chronic disease) may be limited.
The appropriate design of a food tax is paramount to its success. Some studies using modelling have found that a poorly designed tax or subsidy could have unintended consequences and increase certain health risks associated with the consumption of unhealthy foods. Importantly, any food tax must be designed with consideration of the characteristics of the Australian consumer, retail environment and food system. It would therefore be useful if further research was undertaken to explore issues such as size, tax and/or subsidy, type of tax and inclusion criteria, and stage of the food system where the tax is applied (e.g. wholesale sales tax, or sales tax). There is some international research on production versus consumption taxes that could be considered.
Objectives of a potential food tax in Australia
The two potential objectives of any food tax include:
(i) changing diet and health behaviour and improving health outcomes; and
(ii) raising revenue.
A secondary aim may be to encourage meaningful and significant food reformulation to improve the healthiness of the food supply.
Improving health behaviour and outcomes
The evidence is mixed in regards to whether a food tax would be successful at improving health outcomes. There are two components to consider:
- Whether the tax would be able to change consumer behaviour; and
- Whether this change in consumer behaviour would then translate into overall health benefits.
In terms of changing consumer behaviour, a number of studies demonstrate that demand for a number of foods is inelastic (resistant to change) and therefore a tax that increases the price of food would not be expected to significantly alter consumption. However, other experimental studies and consumer attitude surveys have shown that consumers are somewhat responsive to changes in the price of healthy and unhealthy foods. For example, soft drinks have been found to be marginally elastic, with an increase in price of 10% having the effect of decreasing consumption by 11.5%. There is some evidence that consumers shift away from targeted beverages to close substitutes (e.g. Dharmasena et al.) – but not all sugar sweetened beverage studies look at substitution which is a significant limitation. The experience with tobacco taxes was that marginal elasticity can influence consumption and improve population health outcomes.
In terms of health benefits, several studies indicate there is the potential for a food tax to influence weight outcomes, while others find it would not. Those studies that do find that a food tax would influence weight outcomes generally find small effects. Likewise, a number of studies found that a food tax would improve obesity-related health outcomes, including cancer risk, while other studies reported few, if any, health benefits, and even occasionally, negative health effects such as an increased prevalence of diabetes. Though two Australian studies have indicated there would be health benefits from a food tax, these studies use British data on consumer spending. Cancer Council believes it would be highly beneficial to conduct further research to clarify the implications of a food tax on both consumer behaviour, rates of overweight and obesity and the potential health impacts. A further challenge to achieving political will towards food taxes would then be to monetise any benefits that were demonstrated and determine if they outweigh the monetised harms to others including businesses.
In terms of the broader effects on society, evidence overwhelmingly points to a food tax being regressive, with the burden of the tax disproportionately falling upon those on lower incomes, due to the fact that this group spend a larger proportion of their income on food. However, if a food tax is effective in changing diet behaviour, then low income groups who have a greater burden of diet-related chronic disease may potentially see the greatest health improvements. The potential mechanisms to counteract the regressive nature of a food tax (e.g. the use of subsidies on healthy foods such as fruits and vegetables) require further exploration. For example some studies have examined the combination of food taxes and subsidies and concluded that there is potential benefit from the combination.
Food taxes have been criticised for not being able to target those who are obese and impacting upon those people who do not create the costs associated with obesity, but who might occasionally consume those foods that are taxed. However the costs of obesity are borne by broader society, not only those who are overweight or obese. Although one study has shown differential effects between obese and healthy weight consumers, further analysis into the extent to which a food tax would impose additional costs (weighed against the benefits) upon different groups in Australia is recommended.
A number of studies indicate that a food tax imposed on foods which have high levels of consumption has the potential to raise significant revenue. In part, the potential success of a food tax in raising revenue would be based on an expectation that consumers will not change their consumption with an increase in price (inelastic demand). However the taxes on tobacco have resulted in a decrease in consumption, but there has not been a decline in revenue to government because tax rates are high enough to ensure that there is an offset between this and any decline in demand. A consideration for policy makers will be the treatment of any revenue raised from a food tax, and whether it should be hypothecated (ear-marked for a particular use), or considered part of general revenue. In parts of Australia, taxes have previously been introduced that have hypothecated revenue (most notably in the case of tobacco taxation), however there are both advantages and disadvantages to this practice. Supporters of hypothecation argue that it limits a government’s propensity to spend according to their own agenda, while critics retort that they curtail a government’s flexibility to spend when and where it is needed most.
More broadly, the Henry Review of Australia’s Future Tax System recommends that Australia’s future revenue raising be focused on four robust and efficient broad-based taxes (personal income; business income; economic rents from land and natural resources; and private consumption) and therefore introducing a narrow-based tax for the purposes of revenue raising may be in conflict with the Government’s broader taxation priorities. However, the Henry Tax Review also recommended that taxes on specific goods and services may be appropriate if they are for the purpose of improving social outcomes or market efficiency, and therefore a food tax may still be consistent with the recommendations of the Henry Tax Review if there is evidence of improvements in social outcomes. In the food context, the Henry Tax Review noted that there are multiple influences on obesity so it may be difficult to estimate the externalities’ costs of identifiable foods or food types. The Henry Tax Review also noted that any health benefits would need to weighed against the loss to people who are at low risk, i.e. not overweight or obese, as well as other potential negative consequences of a food tax. It follows that modelling to estimate the externalities of consuming foods that may be subject to a tax, together with an exploration of the revenue implications of a food tax, the appropriate design features and consumption/health implications would be beneficial.
Subsidies on healthy foods (e.g. fruit and vegetables), funded wholly or in part from revenue received from food taxes, have been proposed to counter the regressive impact of a food tax and increase healthy food consumption. Subsidies could be applied at one or more points throughout the food system to benefit all consumers, or they could be redeemable by low income groups only (e.g. through the use of food vouchers or stamps in retail outlets).
There is experimental evidence that taxing unhealthy foods and using the revenue to subsidise healthy foods, can improve diets and population health outcomes, particularly in low income households (so long as the appropriate level of any tax/subsidy is carefully determined). For example, modelling in the UK found that a tax on less healthy foods, combined with subsidies for fruit and vegetables (using all revenue generated by the tax) could avert up to 6400 cardiovascular disease and cancer deaths each year (a savings higher than would result from taxes on saturated fat or less healthy foods alone). Modelling suggests that subsidies in combination with food taxes would provide the greatest health benefit, and are the most cost-effective, for disadvantaged consumers.
There is also evidence that subsidies for the transportation of healthy foods in rural and remote areas may improve population health outcomes in these areas. For example, an evaluation of the Canadian Food Mail Program, which subsidises the cost of transporting fresh foods to isolated communities, found that increasing the freight subsidy (as part of a pilot project in three communities) resulted in a significant increase in the purchase of these products.
Further studies or modelling would be valuable to determine the most cost-effective mechanism or mechanisms for subsidising healthy foods (in combination with food taxes) in the Australian context.
Potential for a food tax in relation to other obesity control measures
It is also important to consider how a food tax might perform in relation to other measures aimed at reducing obesity. Cancer Council like other public health organisations, believes a combination of strategies, including social marketing, community programs and policy approaches are required to address overweight and obesity. While two Australian studies indicate that a food tax is a cost effective policy option when compared to other obesity reduction measures, a number of other studies suggest that a combination of measures targeting obesity might be the best option. Further analysis and research are required to consider how a suite of policy measures would interact and what would be the most appropriate design of each so that they produce the best outcomes.
Many of the issues associated with a food tax are extremely complex. Currently, although the existing evidence base is limited by studies of variable quality and comparability, there is some limited evidence supporting the ability of a food tax to actually change behaviour and influence health outcomes. Further research is required to assess the intricacies associated with the design of a food tax and the political and policy environment. Despite this knowledge gap, a number of conclusions can be highlighted in this position statement.
First, the evidence is mixed in regards to whether a food tax would be successful at improving health outcomes. Internationally, food taxes have been shown to affect positive changes in dietary behaviours and potentially influence health outcomes – although consistency and strength of the effect is mixed. There is relatively little Australian evidence regarding the impact of a food tax on dietary behaviour and health outcomes. However, what does exist suggests that a food tax could be a cost-effective policy option for reducing obesity. Further work is required to demonstrate comprehensively if the reduction is minor or significant.
Second, the equity implications of a food tax are an area that is often discussed in both the public debate and literature, with overwhelming evidence suggesting that a food tax is regressive, placing a greater burden on disadvantaged consumers who spend proportionately more of their household income on food. It has been suggested, though not fully explored, that subsidies for healthy foods for these groups could offset these regressive implications. An additional distributional impact of a food tax that also receives public attention is that a food tax will impact all consumers, not only those who are considered to be overweight and obese.
Third, evidence suggests that a food tax has considerable revenue-raising potential. Even a small tax is likely to raise high levels of revenue, which could either be part of general revenue or hypothecated for use in health promotion activities or offsetting the costs of subsidies on healthier foods like fruits and vegetables. However, implementing a food tax, which would be a narrow-based tax, for the purpose of generating revenue may be in conflict with Australia’s broad-based taxation priorities.
Fourth, the appropriate design of a food tax will be a key element in its success and will depend on whether it is intended as a measure to change behaviour and improve health outcomes and/or raise revenue. Issues associated with design include: whether a tax, subsidy or combination be adopted; the unit of measurement (food category or nutrient); at what stage of the food system it is applied; and determining what will be done with the revenue generated.
Finally, there has been little consideration of the effectiveness of food taxes in the context of other policy options. Given the complex issues involved in obesity, fiscal measures used in combination with other policy tools may be most effective.
Priorities for future research relating to food taxes
Modelling a potential Australian food tax
An important next step in determining the potential for a food tax to deliver health benefits in Australia would be to develop a model or a range of models for an Australian food tax and test the health and economic impacts on a range of consumers e.g. from a range of socio-economic groups, overweight and obese consumers as well as those who are a healthy weight.
There is enough evidence internationally to suggest that a food tax could be an important part of an Australian policy response to obesity prevention. Designing an effective food tax would require consideration of whether a tax and/or subsidy would be most appropriate; the food group (e.g. sugar sweetened beverages) or nutrients that a tax could potentially be applied to; the elasticity of the food items to be taxed and cross-elasticity of demand; what size the tax and/or subsidy should take in order to achieve the desired outcomes; at what stage of the food system it is applied; and what will be done with the revenue generated.
Addressing the Australian-specific evidence gaps
There are a number of gaps in the Australian evidence-base that need to be addressed in order to better understand the potential for food taxes to deliver health benefits in Australia. These include:
- Investigate the externalities caused by obesity in order to build the case for regulatory reform, and better understand the impact of the harms in not regulating in this area (ie economic cost-benefit analysis).
- Retrospectively, determine the impact of the impost of the GST and removal of wholesale sales taxes on consumption and dietary behaviours.
- Model the impact of changes in the price of different foods in Australia on changes in consumption, body mass index (BMI) and cancer risk.
- Qualitatively and quantitatively (if possible), identify the differential economic implications of a food tax for different socio-economic groups within Australia, including how incorporating subsidies could reduce the regressivity of a food tax for some sub-groups.
- Quantify the revenue implications from a food tax in Australia.
- Examine how a food tax could interact and complement a possible suite of policy measures, and the combination of policies that are likely to be most effective and equitable.
Position statement details
This statement is based on a issues paper commissioned by Cancer Council Australia and developed by Professor Sharon Friel and Ms Catherine Bradbear of the Australia National University. This statement was reviewed by Cancer Council Australia’s Nutrition and Physical Activity Committee and the Public Health Committee and was published in April 2013.
Cancer Council Australia wishes to acknowledge Associate Professor Bebe Loff, Monash University, and Dr Anne-Marie Thow, University of Sydney, who kindly reviewed an earlier draft of this position statement.
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