Targeted taxes and school lunch policies benefit low-income populations
Two studies highlight the beneficial health effects of a sugar-sweetened beverage tax and the Healthy, Hunger-Free Kids Act of 2010
The studies will be published online July 7, 2020 in Health Affairs.
In the first study, researchers analyzed the influence of an excise tax of 1.5 cents per ounce on sweetened beverages (sugar or artifically sweetened) that was passed in Philadelphia on January 1, 2017. It is the first study to examine the influence of the tax on the purchase of sweetened beverages in small independent stores in urban areas, where sweetened drinks are among the most commonly purchased item.
Philadelphia is the largest of the seven U.S. cities and counties that have a tax on sweetened beverages and, among those localities, it has the highest percentage of racial and ethnic minority groups and people in poverty among its population. These groups are more likely to consume sweetened beverages and are disproportionately affected by health problems linked to excessive consumption of these drinks.
The researchers compared beverage prices and purchases in Philadelphia before the tax's implementation and one year later. They also looked at comparable data from Baltimore, which does not have an sweetened beverages excise tax. The sample included 134 stores and 4,584 customer purchases.
According to the researchers' analysis, the tax significantly increased the price of taxed beverages by 1.81 cents per ounce and decreased the volume of taxed beverages sold by 38.9 percent. Customers shopping in low-income neighborhoods and people with lower education levels purchased slightly less taxed beverages (about 7 fewer ounces) than the overall reduction in the purchase of taxed beverages (about 6 fewer ounces).
According to the researchers, the findings suggest that beverage excise taxes may be an effective policy tool for reducing sweetened beverage purchases among populations at higher risk for sweetened drink consumption.
"Beverage taxes are a policy win-win since they lead people to buy fewer drinks that are bad for health and generate revenue that can be spent on programs such as children's education," said first author Sara Bleich, professor of public health policy in the Department of Health Policy and Management and Carol K. Pforzheimer Professor at the Radcliffe Institute for Advanced Study.
In the second study, a research team led by Erica Kenney, assistant professor of public health nutrition in the Departments of Nutrition and Social and Behavioral Sciences, examined the impact of the Healthy, Hunger-Free Kids Act of 2010 on child obesity risk. The legislation strengthened nutritional standards for meals and beverages provided through the National School Lunch, Breakfast, and Smart Snacks programs. The Act's whole grain standards were relaxed under the Trump administration, but this change was struck down in federal court. Additional rollbacks of the Act's standards have been proposed.
The researchers reviewed data for 173,013 youths taken from the National Survey of Children's Health from 2003-2018, prior to when rollbacks went into effect.
While they found no significant association between the legislation and childhood obesity trends overall, they did find significant reductions in obesity risk among children living in poverty--a population that is particularly reliant on school meals. Among these children, the risk of obesity, which had been trending steadily upwards prior to the legislation going into effect, declined substantially each year following the act's implementation, translating to a 47% reduction in obesity prevalence in 2018 from what would have been expected without the legislation.
The researchers conclude that the Healthy, Hunger-Free Kids Act's science-based nutritional standards should be maintained to support healthy growth, especially among children living in poverty. They also suggest that policymakers consider strategies to increase participation in school meals programs.
"Based on our study, as well as research that USDA and other researchers have conducted showing improvements in diet, the improved school meals standards have been a great public health success story," said first author Kenney. "These healthier school meals are helping to protect the health of the children who have been placed at highest risk for poor health, and they reduce hunger while also reducing their risk of chronic diseases later in life."
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Other Harvard Chan School authors of the Kenney study included: Jessica Barrett, Sara Bleich, Zachary Ward, Angie Cradock, and Steven Gortmaker.
Funding for the Philadelphia beverage tax study came from Bloomberg Philanthropies.
Funding for the Healthy, Hunger-Free Kids Act study came from JPB Foundation (Grant No. 1085). Jessica Barrett, Zachary Ward, Sara Bleich, Angie Cradock, and Steven Gortmaker were supported by the National Institutes of Health (Grant No. R01HL146625). Erica Kenney, Barrett, Bleich, Cradock, and Gortmaker were supported by the Centers for Disease Control and Prevention (CDC) (Grant No. U48DP006376). Gortmaker was supported by the Robert Wood Johnson Foundation.
"The Association Of A Sweetened Beverage Tax With Changes In Beverage Prices And Purchases At Independent Stores," Sara N. Bleich, Hannah G. Lawman, Michael T. LeVasseur, Jiali Yan, Nandita Mitra, Caitlin M. Lowery, Ana Peterhans, Sophia Hua, Laura A. Gibson, and Christina A. Roberto, Health Affairs, online July 7, 2020, doi: 10.1377/hlthaff.2019.01058
"Impact Of The Healthy, Hunger-Free Kids Act On Obesity Trends," Erica L. Kenney, Jessica L. Barrett, Sara N. Bleich, Zachary J. Ward, Angie L. Cradock, and Steven L. Gortmaker, Health Affairs, online July 7, 2020, doi: 10.1377/hlthaff.2020.00133
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Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives--not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.
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