Saturated Fat Tax - Nanny State Tactic or Sound Public Health Policy?

[Dean Pomerleau]

By now everyone has heard of the controversial soda tax being considered by cities and states around the US, and being bandied about by our Presidential candidates (the sane ones anyway...). 

 

Now comes not just news, but actual results from an even more ambitious tax to discourage poor food choices. Here is the background, from the full text of [1] (pop press article):

 

In October 2011, Denmark introduced a tax on saturated fat... 

The tax on saturated fat amounted to 16 DKK/kg saturated fat

(~$1/lb - DP) in the following foods meant for human consumption

if the level of saturated fat exceeded 2.3 g/100 g: meat, dairy

products, animal fats that were rendered or extracted in other

ways, edible oils and fats, margarine and spreads. The resultant

price changes were non-trivial, for example the price of a standard

package of butter at 500 g where the content of saturated fat was

52 g/100 g increased by [~$0.33 - DP] (20%).

 

The researchers in [1] took it as an opportunity to see just what impact such a "sin tax" on food would have on it's consumption and on public health. Here is what they found:

 

The tax resulted in a 4.0% reduction in saturated fat intake. Vegetable 

consumption increased, and salt consumption increased for most individuals,

except younger females. We find a modelled reduction in mortality with 123 lives 

saved annually, 76 of them below 75 years equal to 0.4% of all deaths from 

​[non-communicable diseases]. 

 

Here is the table representing the authors' model of the mortality differences that would result from the dietary changes induced by the tax:

 

 

As you can see, increasing fruit, vegetable and fiber intake, and reducing saturated fat as a result of the tax would appear to save ~175 lives per year, but the extra salt people ate, presumably to compensae for reduced palatability of foods with lower SFA, cost ~41 lives, resulting in a net reduction in 123 lives lost, according to their model, mostly from heart disease avoidance (with some extra strokes due to the salt). This savings represents a relatively small fraction (0.4%) of the total non-communicable deaths in Denmark each year. 

 

Questions remain - namely why such a small effect, both in terms of saturated fat intake (only dropped 4%, despite a pretty hefty tax), and in terms of mortality benefit (0.4%)? And the big question - Has their model born out in the five years since the tax was initiated? Has the mortality rate actually dropped as a result of the saturated fat tax?

 

Unfortunately, the answer to all these questions are related. Apparently and not surprisingly, the Danes hated the tax. Rather than seriously cutting back on SFA, they ended up "trading down" (i.e. buying cheaper alternatives with as much SFA as the original) and/or hopping the border to Germany or Sweden where prices were (not surprisingly) 20% cheaper, according to a Washington Post article.

 

In fact, they didn't like the tax so much that it was repealed after about a year - far too short a time to see if it had any long-term health/longevity benefits.

 

Sad, but not surprising. It just goes to show it is really difficult to legislate healthy behavior. But as US cigarette taxes and settlement have shown, these sorts of "sin taxes" are viable but unfortunately quite regressive ways to raise revenue. Not unlike lotteries...

 

--Dean

 

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[1] Eur J Clin Nutr. 2016 Apr 13. doi: 10.1038/ejcn.2016.6. [Epub ahead of print]

 

The effects of the Danish saturated fat tax on food and nutrient intake and

modelled health outcomes: an econometric and comparative risk assessment

evaluation.

 

Smed S(1), Scarborough P(2), Rayner M(2), Jensen JD(1).

 

Author information: 

(1)Institute of Food and Resource Economics, University of Copenhagen,

Frederiksberg, Denmark. (2)Nuffield Department of Population Health, University

of Oxford, Headington, Oxford, UK.

 

BACKGROUND/OBJECTIVE: The World Health Organisation recommends governments to

consider the use of fiscal policies to promote healthy eating. However, there is 

very limited evidence of the effect of food taxation in a real-life setting, as

most evidence is based on simulation studies. The objective of this study is to

evaluate the effect of the Danish tax on saturated fat in terms of changes in

nutritional quality of the diet, that is, changes in saturated fat consumption,

as well as other non-targeted dietary measures, and to model the associated

changes in mortality for different age groups and genders.

SUBJECTS/METHODS: On the basis of household scanner data, we estimate the impact 

of the tax on consumption of saturated fat, unsaturated fat, salt, fruit,

vegetables and fibre. The resultant changes in dietary quality are then used as

inputs into a comparative risk assessment model (PRIME (Preventable Risk

Integrated ModEl)) to estimate the effect of these changes on non-communicable

diseases (NCDs) and mortality.

RESULTS: The tax resulted in a 4.0% reduction in saturated fat intake. Vegetable 

consumption increased, and salt consumption increased for most individuals,

except younger females. We find a modelled reduction in mortality with 123 lives 

saved annually, 76 of them below 75 years equal to 0.4% of all deaths from NCDs.

CONCLUSIONS: Modelling the effect of the changes in diet on health outcomes

suggests that the saturated fat tax made a positive, but minor, contribution to

public health in Denmark.

 

PMID: 27071513

[Sthira]

Sound public health policy.