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all SSBs purchased did not change substantially, the purchase of the higher-taxed SSBs declined by 22 percent (Nakamura et al. 2018). Mexico’s SSB tax of Mex$1 per liter led to a 6 percent to 12 percent decline in SSB consumption relative to what would have been expected in the absence of the tax (Colchero et al. 2016). Catalonia, Spain, imposed a €0.08 per liter tax on SSBs with less than 8 grams of sugar and €0.12 per liter for products with 8 grams of sugar or more. The tax reduced SSB purchases by 8 percent, partly due to a shift toward the purchase of zero- and low-sugar drinks (Vall Castelló and Lopez Casasnovas 2020). Some studies, however, find no effect of small increases in SSB prices on consumption (Powell, Chriqui, and Chaloupka 2009; Sturm et al. 2010). A 5.5 percent sales tax on soft drinks implemented by Maine in 1991 and a 5 percent sales tax on soft drinks imposed by Ohio in 2003 had no effect on consumption (Colantuoni and Rojas 2015). An SSB tax in Oakland, California, of US$0.01 per ounce did not reduce the consumption of SSBs (Cawley et al. 2020). The regressivity of SSB taxes, like tobacco taxes, is a common concern. A systematic literature review, however, finds that the degree of regressivity of SSB taxes is small. Backholer et al. (2016) report, “A tax on SSB will deliver similar population weight benefits across socioeconomic strata or greater benefits to lower SEP [socioeconomic position] groups.” They conclude that their findings “[challenge] the relevance of the argument pertaining to financial regressivity” (Backholer et al. 2016). Evidence on nutrition labeling has generally shown front-of-package (FOP) traffic light and warning labels to be more effective than back-of-package (BOP) nutrition labeling (table 7.10). Overall, with the exception of a modeling study by Huang et al. (2019), the literature suggests that back-of-package labeling is not effective because it is often difficult for consumers to understand. Therefore, it also seems likely that minor changes to the label—such as adding a line for added sugar—will have little or no effect. Because of the deficiencies of BOP nutritional information panels (NIPs), increased attention has been devoted to
TABLE 7.10 Evidence
on effectiveness of BOP and FOP labeling
INTERVENTION
RESEARCH FINDINGS
REFERENCES
Back-of-package nutrition labeling
Many countries either mandate or recommend the inclusion of a nutritional information panel (NIP) on the back of prepackaged foods and beverages to assist consumers in making healthier food choices. However, the NIP is difficult for many consumers to understand, and there is little evidence to suggest that this strategy has positively influenced dietary outcomes.
Cha et al. 2014; Helfer and Shultz 2014; Huang et al. 2019; Khandpur, Rimm, and Moran 2020; Variyam 2008
Front-of-package nutrition labeling
Many countries are now mandating specific FOP labels. Five countries— Canada, Chile, Israel, Peru, and Uruguay—require that unhealthy products display warning logos placed inside black stop signs. Several Western European countries use Nutri-Score, a label developed in France that assigns a single score to each product based on the product’s overall healthfulness. Singapore is soon to adopt a similar approach. Many studies—both randomized and unrandomized— indicate that warning labels, traffic light labels, and Nutri-Score labels induce small improvements in the healthfulness of consumers’ purchases, even in the presence of the NIP. Greater effectiveness may be realized if FOP labels are combined with taxes and other interventions.
Borgmeier and Westenhoefer 2009; Finkelstein et al. 2019; Gorski Findling et al. 2018; Hawley et al. 2013; Maubach, Hoek, and Mather 2014
Source: Original compilation for this publication. Note: BOP = back-of-package. FOP = front-of-package. NIP = nutritional information panel.
