On 14 June 2024, as we have seen, WHO published its latest recommendations on the fiscal policies necessary to promote balanced nutrition and reduce the public health costs associated with the consumption of junk food (1,2).
In fact, scientific evidence demonstrates how the taxation of foods with unbalanced nutritional profiles and subsidies for the purchase of healthy foods can stimulate populations to improve their diet, health and quality of life (3,4).
1) Unhealthy diets, a serious risk to public health
Unhealthy diets pose a significant risk to public health globally, contributing to malnutrition and a range of serious, non-communicable diseases (NCDs).
UNICEF and WHO offer some insights into the ‘double burden of malnutrition’ in the child population. In 2020, according to always approximate estimates, at least 38,9 million children under five years of age were obese or overweight, while 45,4 million were affected by malnutrition and 149,2 million suffered from growth retardation disorders (stunting ). (5)
Fight malnutrition is therefore one of the major challenges for public health at a global level, considering its impact on the health of children and adolescents as well as its burden on national economies.
2) WHO, recommended fiscal policies
WHO (World Health Organization) has therefore updated the recommendations addressed to its 194 members, so that fiscal policies can influence the food market and thus people’s behavior, to help reduce the serious public health risks associated to imbalances in nutrition.
‘The actions of agribusinesses, manufacturers and retailers are increasingly influencing food prices and affordability – as well as availability, safety and desirability – and, in current food systems, it has become challenging for consumers “to make healthy and affordable food choices consistent with optimal nutrition outcomes”. Although the cost of a healthy diet differs across major world regions and World Bank income groupings
– a healthy diet that reflects global guidance is currently unaffordable for almost 3.1 billion people
– at the same time, unhealthier options, such as sugar-sweetened beverages (SSBs) have become
easingly affordable
– the inverse relationship between food prices and food purchases and
consumption indicates that taxes can reduce, and subsidies can increase, consumption of targeted foods’. (2)
2.1) Taxation of Sugar-Sweetened Beverages (SSBs)
Taxation of Sugar-Sweetened Beverages (SSBs) is essential to reduce the consumption of added sugars which already in 2022 EFSA (European Food Safety Authority) recommended to be reduced to the minimum possible, as it is associated with greater risks of a series of serious and chronic diseases starting from type 2 diabetes. ( 5)
The scientific evidence recalled by WHO shows that a 10% increase in the price of SSBs could reduce their consumption by 16%. Furthermore, the ‘sugar tax’, as seen in the UK, encourages the reformulation of products to reduce the sugar content. (7)
The experiences of ‘food tax’ – whether based on saturated fat content (e.g. Denmark) or sugar content (e.g Romania) in foods, or rather on their nutritional profiles, are unfortunately still scarce. It was therefore not possible to collect studies capable of confirming its specific effectiveness.
2.2) Subsidies for healthy foods
The populations must also receive economic incentives to purchase healthy foods, such as public health ingredients and disease prevention tools. Consideration is given to fruit and vegetables, but also to natural and minimally processed foods (according to NOVA classification), as well as balanced from a nutritional point of view (see the next paragraph).
This type of intervention is fundamental for healthier food choices and can be expressed both through indirect taxation, through VAT reduction on the most nutritionally balanced food categories, and through food vouchers for the weakest sections of the population. Very positive results were found in India, where the intake of proteins from legumes increased, and in the USA where the Healthy Eating Score Index improved.
2.3) Healthy foods, which ones?
‘Foods that contribute to a healthy diet: nutrient-dense foods rich in naturally occurring fibre and/or unsaturated fatty acids, low in saturated fatty acids, trans-fatty acids, free sugars and salt, free of non-sugar sweeteners, and/or the consumption of which is associated with positive health outcomes’. (2)
The criterion to distinguish healthy foods from those that do not contribute to a healthy diet – and must therefore be avoided or at least consumed in minimum quantities and frequency – responds to the nutritional profiles model (e.g. NutriScore).
‘Nutrient profile model: a tool for classifying foods and beverages according to their nutritional composition for reasons relating to disease prevention and health promotion. In the context of fiscal policies to promote healthy diets, nutrient profile models provide one means of defining foods and beverages to be taxed or subsidized’. (2)
3) Nutritional policies and local contexts
Nutritional policies must be adapted to local contexts, as well as to the cultures and traditions of people. And it is essential that fiscal policies form part of a broader strategy that must include:
– a nutritional information system on the front of the labels (FOPN, Front-of-pack nutrition labelling, i.e. NutriScore in Europe, ‘warning labels’ in Latin America and Canada. See notes 8,9)
– restrictions on the marketing of nutritionally unbalanced foods (10,11). It is also useful to consider restrictions on the sales of ‘HFSS (High in Fat, Sugars and Sodium) food’ in vending machines, as well as in the vicinity of schools, hospitals and public institutions (12,13,14).
4) Virtuous examples
Taxes on SSBs and drinks with artificial sweeteners have confirmed their effectiveness in reducing consumption and improving public health. Modeling studies show that a tax on sugary drinks could prevent thousands of cases of obesity and diabetes each year, with significant savings for health systems. Some examples:
– in Mexico, the tax on SSBs led to a 7,6% reduction in sales in the first year of application,
– in the United Kingdom, the ‘soda tax’ has made it possible to reduce the average weekly intake of sugars by 30 g per capita.
Subsidy policies for the purchase of healthy foods in turn, although less widespread, show promising results. Discount programs on fruit and vegetables have increased their consumption in low-income populations, improving the quality of nutrition and reducing the risk of chronic diseases. In the United States, a fruit and vegetable subsidy program led to a significant increase in their consumption (+25%) among beneficiaries.
5) Economic and social equity considerations
Tax policies in the field of nutrition they can produce significant economic benefits for the States that adopt them, both in terms of reducing health costs and increasing economic productivity. A universal tax on sugary drinks could save up to $20 billion in healthcare costs alone over the next 20 years.
These policies can also reduce health inequalities by making healthy food options more accessible to all segments of the population regardless of income categories. A tax on foods high in sugar, for example, could reduce the prevalence of obesity by 4% in high-income countries, according to WHO. Without neglecting the benefits also in low- and middle-income countries. (16)
6) How to design tax reforms
The design of fiscal policies is crucial to their effectiveness. WHO recommends specific taxes on products with added sugars and a clear definition of taxable products.
Subsidy measures must aim to reduce the prices of foods with high nutritional value and promote their availability in local markets.
Monitoring and impact evaluation of fiscal policies is also essential to ensure the achievement of public health objectives and make any necessary reforms.
7) Political challenges
Prepare for opposition from Big Food can increase the effectiveness of fiscal policies. WHO provides strategies to strengthen governments’ positions against legal and political challenges from junk food corporations, highlighting the importance of evidence-based policies and developing multi-sectoral coalitions. (17)
Governments can design taxes to minimize the impact on low-income families, using the proceeds to fund nutrition and public health programs. Involving local communities and other stakeholders in the development of these policies is crucial to ensure that the concerns of all parties receive consideration.
8) Provisional conclusions
The role of fiscal policies in promoting balanced nutrition it is essential to public health policies, in the necessary logic of prevention and mitigation of the related risks. Scientific evidence supports the adoption of these fiscal policies as part of a broader strategy to create food environments conducive to healthy and sustainable choices.
The WHO guidelines provide a detailed, evidence-based framework for implementing fiscal policies that promote healthy diets. If implemented correctly, these policies can significantly reduce the prevalence of diseases related to nutritional imbalances and improve the quality of life of populations around the world. Governments must take action, starting with the European Union and its Member States. (18)
Dario Dongo
Footnotes
(1) Dario Dongo. The new WHO guidelines on fiscal policies for a healthy diet. GIFT (Great Italian Food Trade). 16.6.24
(2) Fiscal policies to promote healthy diets: WHO guideline. World Health Organization, Geneva. 2024. ISBN: 978-92-4-009101-6
(3) Dario Dongo, Sabrina Bergamini. Sugared and sweetened drinks, sweet snacks. Studies on premature mortality and sugar tax. GIFT (Great Italian Food Trade). 10.9.19
(4) Marta Strinati. Sugar tax. 5.000 fewer cases of obesity among British girls. GIFT (Great Italian Food Trade). 28.1.23
(5) United Nations Children’s Fund, World Health Organization, World Bank Group. Levels and trends in child malnutrition: UNICEF/WHO/The World Bank Group joint child malnutrition estimates: key findings of the 2021 edition.World Health Organization. 2021 https://iris.who.int/handle/10665/341135
(6) Marta Strinati. The harmful role of sugars in the diet, EFSA opinion. GIFT (Great Italian Food Trade). 1.3.22
(7) Dario Dongo, Carlotta Suardi. Orange, in Italy double ration of sugar. GIFT (Great Italian Food Trade). 17.7.18
(8) Dario Dongo. Codex Alimentarius, the NutriScore and the WHO guidelines. GIFT (Great Italian Food Trade). 29.9.21
(9) Dario Dongo. Canada, label warnings on saturated fats, sugars and salt. GIFT (Great Italian Food Trade). 16.7.22
(10) Sabrina Bergamini. Food marketing promotes unhealthy diets for children and teens. WHO report. GIFT (Great Italian Food Trade). 28.2.22
(11) Dario Dongo, Andrea Adelmo Della Penna. ‘Audiovisual Media Services Directive’ and protection of minors from junk food marketing. GIFT (Great Italian Food Trade). 25.11.23
(12) Dario Dongo. Changing the offer in vending machines reduces the risk of youth obesity. Study. GIFT (Great Italian Food Trade). 23.9.23
(13) Dario Dongo, Marta Strinati. Junk food expelled from school, the example in India. GIFT (Great Italian Food Trade). 6.11.19
(14) Dario Dongo. Mexico, protection of minors from junk food. The prohibitions are triggered. GIFT (Great Italian Food Trade). 26.8.20
(15) Marta Strinati. Artificial sweeteners increase cardiovascular risk. GIFT (Great Italian Food Trade). 7.2.23
(16) Marta Strinati. Colombia, the tax on ultra-processed foods is underway. GIFT (Great Italian Food Trade). 9.11.23
(17) Marta Strinati, Dario Dongo. Nutrition and health, here’s how Big Food stands in the way of the WHO. GIFT (Great Italian Food Trade). 3.9.20
(18) Sabrina Bergamini, Dario Dongo. Obesity, childhood obesity and marketing. WHO Europe 2022 report. GIFT (Great Italian Food Trade). 16.6.22
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
