Fiscal policies to improve access to healthy dietary choices or to discourage the consumption of less healthy options are well-known. Examples are subsidies on fruits and vegetables and taxes on sugar-sweetened beverages or foods high in sugar, saturated fat or salt. There is strong evidence that these policies are effective if appropriately designed and implemented (Thow, et al., 2018).
The World Health Organization (WHO) recently published a briefing document on fiscal policies to promote healthy diets (World Health Organisation, 2022). WHO recommends the use of fiscal policies that influence the relative price of foods and beverages, including both taxes on foods and beverages that are high in fat, sugars, or salt, and subsidies on foods that contribute to a healthy diet. However, these recommendations are not new and the good news is that in recent years, the implementation of taxes on sugar-sweetened beverages has strongly increased. As of May 2022, 85 of the 194 Member States (44%) have implemented such taxes. Taxes on foods high in salt, sugar, and fats are less widely implemented, but have also seen increased adoption; as of 2022, 29 Member States (15%) have such taxes implemented. Subsidies on foods that contribute to a healthy diet are less widely implemented. Among WHO regions in 2019, South-East Asia led, with 18% of countries reporting subsidies, followed by the Eastern Mediterranean with 10%, the Western Pacific with 7%, and Africa, the Americas and Europe with just 6% (World Health Organisation, 2022).
An important aspect of the fiscal policy design is the question of which foods and beverages are to be taxed or subsidised. For example, the Dutch government considers lowering the VAT tariff on fruits and vegetables from 9% to 0%. However, the responsible ministers wrote a letter to parliament that clearly defining which fruits and vegetables should be included in the VAT 0% tariff is “a puzzle”. They refer to processed fruit and vegetable products, which are considered by consumers and traders as fruits and vegetables but where it is not clear whether these products are healthy. WHO recommends that fiscal policies are implemented as part of a coherent policy package, supported by a nutrient profiling model.
And this is exactly what we, at Choices International Foundation, do. We have extended our nutrient profiling model not only to support front-of-pack labelling but also to support other food system actions such as fiscal policies (Tognon, et al., 2021). If taxes and subsidies were based on a nutrient profiling model that is also used for a mandatory graded front-of-pack labelling scheme, the “puzzle” would be solved and consumers and traders would recognise healthy and unhealthy products by their mandatory front-of-pack label. For example, a product such as canned tomatoes could carry the highest grade front-of-pack label if it is compliant with the nutrient profiling criteria underpinning the labelling system and would fall under the subsidised or 0% VAT tax regime. However, canned tomatoes with added salt exceeding the threshold level criteria would not be eligible for the highest grade and would not be eligible for favourable taxes.
Governments should use a nutrient profiling system to support a coherent package of nutrition policies, such as front-of-pack labelling, product reformulation, fiscal policies and marketing restrictions. If such a nutrient profiling system is credible, regularly reviewed and well aligned with national food-based dietary recommendations, such a coherent policy package is easier to understand by consumers and trade, which would facilitate the implementation and enforcement.
Plan van aanpak prijsmaatregelen voeding. (2022, July 5). Retrieved July 12, 2022, from Tweede Kamer: https://www.tweedekamer.nl/kamerstukken/brieven_regering/detail?did=2022D29115&id=2022Z14090
Thow, A. M., Downs, S. M., Mayes, C., Trevena, H., Waqanivalu, T., & Cawley, J. (2018). Fiscal policy to improve diets and prevent noncommunicable diseases: from recommendations to action. Bull World Health Organ, 201-210.
Tognon, G., Beltramo, B., Schilpzand, R., Lissner, L., Roodenburg, A., Don, R., . . . Smorenburg, H. (2021). Development of the Choices 5-Level Criteria to Support Multiple Food System Actions. Nutrients, 13, 4509.
World Health Organisation. (2022, June 7). Fiscal policies to promote healthy diets: policy brief. Retrieved July 12, 2022, from WHO: https://www.who.int/publications/i/item/9789240049543