Transcript presentation - Canadian Public Health Association

Food price interventions to
address socioeconomic
determinants and disparities in
obesity prevention
Barbara von Tigerstrom
Assistant Professor
College of Law
University of Saskatchewan
Law and obesity
• Project: “The use of legal interventions to
address environmental factors implicated
in the obesity epidemic: the role of law as a
public health tool” (CIHR MOP 81162)
• Law as a framework, tool, or barrier in the
pursuit of public health goals
• Regulatory interventions: e.g. taxes and
subsidies, regulation of marketing and
labelling
Obesity as a public health concern
• Almost 60% of adults & more than 25% of
children in Canada overweight or obese
• Health consequences including
cardiovascular disease, type II diabetes,
some cancers, joint problems; significant
increases in morbidity and mortality
• Estimated total cost in Canada: $4.3
billion/yr; direct health care costs: $1.6
billion/yr
Causes and contributors
• Individual factors
– Biological, e.g. age, gender, genetics
– Behavioural, e.g. lifestyle, activity level, diet
• Social, economic, cultural and
environmental factors
– e.g. income levels and distributions,
employment patterns, food prices,
advertising, built environment
Obesity and socioeconomic status
• Generally higher rates of overweight &
obesity:
– Lower income
– Lower level of education
– Rural v. urban communities
– Aboriginal populations
• Contributing factors
– e.g. food insecurity, food costs, opportunities
for physical activity
Economic factors and diet
• Food insecurity experienced by approx. 15% of Canadian
households
• Lower-income and insecure households buy more
energy-dense foods
– Consumption of energy-dense foods associated with higher
energy intake
• Lower-income households consume less fruits and
vegetables (but similar energy intake)
• Lower-income spend less on fruit and vegetables, on
food generally
• Average cost of “healthier” food basket 17-19% higher
Price and access interventions
• Taxes
– “fat” tax, “junk food” tax
– Increasing price of foods to discourage
consumption
• Subsidies
– Subsidize or decrease tax on “healthy” foods
– Decreasing price of foods to encourage
consumption
Arguments for tax/subsidy
interventions
• Tax would force producer &/or consumer
to internalize “true” cost
• Studies show that choices may be
influenced by price (+/-), more than
educational messages
• Tax revenue could be used to fund
subsidies or other public health initiatives
Difficulties with tax/subsidy
interventions
• Difficulties of classification and targeting
• Potential effect difficult to predict/assess
– Price and cross-price elasticity of demand
– Substitution effects
– Study environment v. “real-world”
• Tax would be regressive; subsidy could be
progressive but may not be
• Large amounts likely needed to be effective
• Potential trade law issues (depending on design)
• Political and industry resistance to taxes
Assessment
• More likely to be effective in limited, closed
environments
• In general population, would need
comprehensive approach to address substitution
effects – still risk of unintended consequences
• Levels required for significant impact unlikely to
be politically feasible
• As a way of addressing disparities, a limited and
superficial solution to complex problem
Bigger picture – barriers to healthy
food choices
• Economic
– Cost of “healthier” diet
• Social / cultural
– e.g. social norms, cultural appropriateness
• Physical access
– e.g availability of fresh fruits and vegetables, grocery
stores v. fast food outlets
• Legal
– e.g. zoning, licensing; regulation of food content
Bigger picture – potential policy
measures
• Impact of agricultural subsidies
– Total federal spending in 2006-07 $8.4b; highest
support for corn, soybeans (feed), tobacco, beef, milk
• Addressing other dimensions of access
– Zoning, licensing, public transport, transport
subsidies, business incentives
• Promoting and facilitating self-sufficiency in
rural, remote, and Aboriginal communities
– Community support, planning, environmental
protection
– Facilitating return to traditional diets
• Addressing root causes directly