Mexico’s sugary drinks tax – behind the scenes€¦ · Sánchez-Pimienta TG. J Nutr...

Instituto Nacional de Salud Pública

Mexico’s sugary drinks tax – behind the

scenes

Dr Juan A. Rivera

Instituto Nacional de Salud Publica Mexico


Content

•Synopsis of process that led to the tax approval

•Generation and use of scientific evidence by the National Public Health Institute to justify and design the tax

•Evaluation of the effects of the tax on price, sales volume and other outcomes, and use of the evaluation results to maintain the tax

•Lessons learnt that can be applied by cancer societies in their advocacy and lobbying work


Synopsis of process that led to the approval of the tax

SSB´s tax approved

SCIENCE

Science (Research Institution)

Incoming Administration and

Congress

INSP Need of Government

Revenue

Public debate about Obesity,

food environment and high intake of

SSB´s

Food and Beverage

Industry: a Strong force

against the tax Legislative and

Executive Branches of Government PROCESS IN SENATE 2013 • A Champion proposed $2 pesos/L tax • Executive proposed a $1 peso/L tax • Senate approved the $1 peso proposal • Resolution on use of tax revenues

• Industry attempted to reverse the tax in 2015 but failed • Proposal to increate tax to $2/L in 2016 also failed


Evidence about Nutrition transition in Mexico


%

17.2 19.7 20.29

21.9 22.5 23.7 2536.1 36.9 35.4

8.312.6 11.8 6.4 10.9 12.1 9.5

24.932.4

1.5

35.2

0

10

20

30

40

50

60

70

80

1999 2006 2012 1988 1999 2006 2012 1988 1999 2006 2012

Overweight Obesity

Children 5-11 y Adolescent girls (12-19 y)

Women (20-49 y)

Prevalence of overweight and obesity * in children 5-11 y, adolescent girls and women (1988 to 2012)

25.5

32.3

11.1

28.3 33.4 32.0 35.8 34.5

61.0

69.3 70.8


The need of a comprehensive multicomponent strategy for obesity prevention

POLICY AREA SPECIFIC POLICY ACTIONS IN MEXICO

N Nutrition label standards and regulations on the use of claims and implied claims on foods

GUIDELINE DAILY AMOUNTS (GDA´S) SYSTEM

O Offer healthy foods and set standards in public institutions and other specific settings

FOOD AND BEVERAGE REGULATIONS IN SCHOOLS

U Use economic tools to address food affordability and purchase incentives

TAXES ON SSB´S AND JUNK FOOD

R

Restrict food advertising and other forms of commercial promotion REGULATION OF MARKETING TO CHILDREN IN TV AND MOVIE THEATERS DURING SELECTED SCHEDULES & PROGRAMS

I Improve the nutritional quality of the whole food supply NO NATIONAL POLICY

S Set incentives and rules to create a healthy retail and food service environment ISOLATED EFFORTS (NUTRITION EDUCATION IN GOVERNMENT

OWNED RURAL RETAIL STORES)

H Harness the food supply chain and actions across sectors to ensure coherence with health

NO NATIONAL POLICY

I Inform people about food and nutrition through public awareness CAMPAIGN PROMOTING GENERAL BEHAVIORS: MINDFUL EATING,

MOVING AND ATTENDING PRIMARY HEALTH CLINICS

N Nutrition advice and counselling in health care settings

DIETARY GUIDELINES RELEASED LAST YEAR IN THE PROCESS OF IMPLEMENTATION IN PHC

G Give nutrition education and skills NO NATIONAL POLICY


HIGH INTAKE OF SUGAR SWEETENED BEVERAGES


High Intake of added sugars and sugar-sweetened beverages in Mexico • WHO recommends reducing the

intake of free sugars to less than 10% of total energy intake

• Added sugars contribute 12.5% total energy intake in Mexican diet (60 gr/person/day)

• Sugar-sweetened beverages (SSBs) contribute 70.3% of added sugars

• Sánchez-Pimienta TG. J Nutr 2016;146(Suppl):1888S–96S. • López Olmedo N, y Col. J Nutr 2016;146(Suppl):1856S–65S. • Rodríguez-Ramírez S. y Col. J Nutr 2016;146(Suppl):1916S–23S

% of Mexicans consuming >10% of total energy from added sugars

Age Males Females

1-4 y 60.2%

5-11 y 57.8% 65.9%

12-19 y 70.8% 84.6%

≥ 20 y 63.8% 64.1%

•Non-dairy SSBs consumed by: • 12% of infants <6 mo • 36% of infants 6-11 mo • 65% of child 12-23 mo


Evidence about health effects of SSB and added sugars

Meta-analysis by Te Montenga, Mallard S, Mann J (BMJ, 2013)


Health Effects of SSB´s and Added Sugars


National Recommendations of the use of taxes to fight obesity in Mexico

2007 Evaluate the use of policy instruments such as…taxes …

to reduce the consumption of less healthful foods and

beverages

2008 One of the policy

recommendations was to consider taxing soda Initiated a public debate about the effects of SSB

on health which eventually led to

banning SSB in schools and the SSB tax

2012 - Consider Taxing unhealthy processed food (SSB and Junk Food) - Need own and cross price elasticities estimates - Use of tax revenue for obesity prevention

Beverage recommendations for Mexico (2008)


International Recommendations

Public policies can influence prices through taxation, subsidies or direct pricing in ways that encourage healthy eating and lifelong physical activity

WHO recommends reducing the intake of free sugars to less than 10% of total energy intake and a further reduction of the intake of free sugars to below 5% of total energy intake

Use economic tools to address food affordability and purchase incentives


Price elasticity demand for soft drinks

* p<0.01 Elastic Demand

Colchero MA, Salgado JC, Unar M. , Hernández M., Rivera JA. Price elasticity of the demand for soft drinks in Mexico. Economics and Human Biology ttp://dx.doi.org/10.1016/j.ehb.2015.08.007

Elasticity larger for the poorest population Cross-price elasticity results indicate healthy substitutes (water)


Mathematical modeling* for projections of effect of soda tax on body weight and diabetes prevented cases

Prev. cases 2030 (X 1000)

2050 (X 1000)

10% Tax 400 - 630 977 – 1,420

20% Tax 800 – 1,275 1,960 – 2,870

30% Tax 1,200 – 1,920 2,955 – 4,350

Barrientos Gutiérrez T, Meza Rodríguez R, Rodriguez ER, Zepeda Tello R

71.3 70.9 70.5 70.1

*Hall KD model (with microsimulation to allow projections for each individual)


• A 6 percent average decline in purchases of taxed beverages over 2014 compared to pre-tax trends.

• Difference accelerated over 2014 and reached 12% by December 2014.

• A 4 percent increase in purchases of untaxed beverages over 2014

Evaluation of the tax: changes in purchases after the implementation of the tax

Colchero MA, Popkin BM, Rivera JA, Ng SW.. BMJ 2016;352:h6704


All socioeconomic groups reduced purchases of taxed beverages. Reductions higher among lower socio-economic households, averaging 9% decline over 2014 compared to pre-tax trends

Evaluation of the tax: changes in purchases after the implementation of the tax

LOW SOCIOECONOMICSTATUS

MIDDLE SOCIOECONOMICSTATUS

HIGH SOCIOECONOMICSTATUS


Essential data for advocacy and action

• High and growing prevalences of overweight and obesity and co-morbidities

• SSB´s intake is a risk factor for obesity and chronic diseases • Dietary intake of SSB´s in all ages well above WHO upper limit • Own and Cross Price Elasticity of Demand for SSB´s • Fiscal Revenues for different tax designs • Modeling effects of a SSB Tax on obesity and health outcomes • Potential use of revenues for obesity prevention • Taxing SSB´s part of a comprehensive obesity prevention strategy • Evaluation of effects on prices and purchases


Conclusions

Factors which were instrumental for success of the tax: •Monitoring and research by INSP was key in justifying the need for a SSB tax as part of a comprehensive strategy for obesity prevention in Mexico •The Nutrition Transition information and its dissemination set the stage for the need of policy actions for obesity prevention •Information about the high intake of SSB´s and their harm to health justified actions targeted to discourage their intake •The elasticity studies as well as modeling their potential health impact justified SSB´s taxes


Conclusions

Factors which were instrumental for success of the tax: •Local as well as international recommendations about the need to limit added sugar and SSB´s intake and to use fiscal policies •Evaluation of the changes in prices and purchases after the tax documented that the tax is working and was key for defending the tax against industry´s attempts to reverse •Generation of evidence by INSP and strategic partnership were vital for tax approval and defense


www.insp.mx

Mexico’s sugary drinks tax – behind the scenes€¦ · Sánchez-Pimienta TG. J Nutr...

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