Background and objectives:
The WHO recommends the use of fiscal policies to promote healthy eating, but underline that the use of fiscal instruments might have potential regressive effects. However, there is very limited real-life evidence of the effect of food taxation, and even less on the potential regressive effects, 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 i.e. changes in saturated fat consumption as well as other non-targeted dietary measures and to model the associated changes in NCD mortality for different socio-demographic groups.
Methods:
Based on household scanner data we estimate the impact of the tax on consumption of saturated and unsaturated fat, salt, fruit, vegetables and fiber. The resultant changes in dietary quality are then used as inputs into a comparative risk assessment model (PRIME) to estimate the effect of these changes on Non-Communicable Disease mortality. We estimate the effects for four different educational groups; no education, vocationally trained, short tertiary education and long to medium tertiary education, using education as a proxy for socio-demographic status.
Results:
The tax resulted in a 4.0% reduction in saturated fat intake on average with largest decrease among those with no education or medium to long tertiary education. Vegetable consumption increased especially for vocational trained and short educated. Salt consumption increased for most individuals, but mostly for short educated. We find a modelled reduction in annual NCD mortality per 100.000 persons of 3 lives saved for those with no education, 5.1 lives saved for the vocationally trained, 1.7 lives extra lost for the short educated and no change for the medium to long educated. All educational groups experience an increase in food-expenditure due to the tax. Largest increases are found for short and medium to long educated.
Conclusions:
Modelling the effect of the changes in diet on health outcomes suggests that the saturated fat tax made a positive contribution to public health in Denmark. The effects are regressive in terms of NCD mortality, but progressive economically.