early impacts of the uk soft drinks industry levy on the...
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MRC Epidemiology Unit
Early impacts of the UK Soft Drinks Industry Levy on the food system and public health South West Public Health Conference, 19th March 2019 Prof Martin White Centre for Diet & Activity Research, MRC Epidemiology Unit
MRC Epidemiology Unit
The Study Team
Dr Peter Scarborough
Prof Mike Rayner Dr Richard Harrington
Prof Richard Smith Prof Steven Cummins Dr Harry Rutter
Prof Martin White Dr Jean Adams
Dr Oliver Mytton
Dr Adam Briggs
Vyas Adhikari
Lauren Bandy
Dr Marcus Keogh-Brown
Dr Henning Tarp-Jensen
Cherry Law
Dr Tarra Penney
David Pell
Hannah Forde
Dr Linda Cobiac
MRC Epidemiology Unit
The Soft Drinks Industry Levy
• National policy designed by HM Treasury
• To encourage reformulation - a two-tiered levy on large* manufacturers and importers of identified soft drinks**
• Approximately 2 years between announcement to implementation, each event likely to have impacts
• Promise that funds raised from levy will fund children’s health initiatives (e.g. school sports and healthy school breakfast clubs)
Exemptions * <1 million liters per year ** <5g/100ml of added sugar, milk based drinks, pure fruit juices, alcohol
MRC Epidemiology Unit
Context and timeline
• 2015 May – WHO recommends Fiscal policies to improve diet and prevent NCDs
• 2015 July – The Scientific Advisory Committee on Nutrition Report on Carbohydrates and Health endorses WHO recommendations
• 2015 Sept – Jamie Oliver Sugar Rush documentary on Channel 4 + Restaurant SSB levy
• 2015 Oct – Jamie Oliver attends Health Select committee + Sugar Reduction Report from PHE
• 2016 Mar - Levy Announcement
• Ongoing media coverage
• 2018 April – Levy Implementation
MRC Epidemiology Unit
Simplified value chain of soft drinks industry
Syrup producer Bottler, Manufacturer,
Importer
Distributor Retailer Consumer
Imposed at point of production or importation
Simplified soft drinks industry supply chain
Aim: Reduction of sugar consumption in population
Primary mechanism: reformulation, not price change
MRC Epidemiology Unit
Initial research: rapid funding grant from NIHR
1. Evidence review, theorising and system mapping
2. Stakeholder consultation for organisational view – verification of map using online Delphi
3. Mapping of data sources to system map to determine viability of experimental design
4. Establish baseline data collection from non-routine sources
• Qualitative interviews with stakeholders
• Governmental discourse
• News and social media discourse on sugar and the SDIL
• Public attitudes to sugar and SDIL
5. Develop protocol and grant application for evaluation
MRC Epidemiology Unit
Initial system map – input to system mapping workshop
Chancellor’s announcement
Pre-announcement
advocacy
Excise levy on SSBs
Δ Media & public discourse
Δ public attitudes, awareness & social
norms re SSBs
Reformulation of existing products
Development of new products
↑ Price of SSBs
Δ price of other products
↓ purchasing of SSBs
Δ purchasing of other products
Δ whole diet composition
Δ acute & chronic disease
risk factors
Δ acute & chronic health
outcomes
↑ funding for school sports
↑ funding for school breakfast
Δ physical activity
Δ in other health behaviours
Δ food sector profits
Δ food sector employment
Δ marketing of SSBs & other
products
MRC Epidemiology Unit
SDIL evaluation design
5 work packages over 3 two-year time periods (2014-20). 1. Interrupted time series analyses to evaluate impacts of the SDIL
on: • Soft drink product diversification, formulation & price,
marketing, purchases, consumption • Prevalence of childhood obesity & hospital admissions for
severe dental caries 2. Modelling health outcomes over short (5 years), medium (5-10
years) & long term (>10 years). 3. Micro-economic & macro-economic evaluation to assess wider
impacts of SDIL on industry, households, Treasury and UK economy
4. Qualitative methods to determine the perceived acceptability & impacts of the SDIL - interviews with professionals & the public, thematic content analysis of news articles & social media (twitter), governmental discourse
5. Regular updating of systems map, integration and synthesis of findings from WPs1-4 , refinement of intervention theory.
Prior to announcement Apr 2014- Mar 2016
Announcement to implementation Apr 2016- Apr 2018
Following implementation Apr 2018- Mar 2020
MRC Epidemiology Unit
Work package 1a: impact on market diversity, sugar content and price Lead: Dr Peter Scarborough Nuffield Department of Population Health, University of Oxford
The impact of the SDIL on sugar content
1. Retrospective data collection a) 4 major supermarkets, 68% of market share b) Data from 1st of each month from August 2015 to
September 2018 (38 time points) c) Sugar content, ingredients, volume, price of all soft
drinks (n~4000) d) Controlled interrupted time series analysis
2. Prospective data collection a) Custom built web scraping and data management
software b) Data for 1 month before (from 9th march 2018) and
one month after implementation of SDIL (from 11th May 2018)
c) Sugar content, ingredients, volume, price of all soft drinks from 7 major supermarkets with online sales
d) Sankey plots, plus logistic regression and Chi-squared analyses
BrandView
MRC Epidemiology Unit
Next steps
1. Controlled interrupted time series investigating: i. Price (and pass-through rate) ii. Market diversity (e.g. rate of new product entries in each levy
category) iii. Portion sizes
2. Follow-up time series analysis with extra six months (i.e. up to March 2019), to explore whether fall in sugar content has plateaued
3. Further follow up March 2020
MRC Epidemiology Unit
Work package 1b-d: Impact on purchases and consumption of SSBs, and early health impacts Lead: Dr Jean Adams Centre for Diet & Activity Research, MRC Epidemiology Unit
MRC Epidemiology Unit
Research questions
Was the announcement or implementation of the SDIL associated with a change in:
• Purchases of: drinks, a high-sugar substitute (confectionery), an unrelated category (toiletries)?
• Commercial household purchasing data • Consumption of: drinks, confectionary, total free sugars?
• Nutritional surveillance data • Prevalence of: childhood obesity, hospital admissions for dental
caries? • Childhood obesity surveillance data; hospital admission data
MRC Epidemiology Unit
Purchasing – data & analysis
• Kantar WorldPanel • commercial household purchase panel; n~30,000 households • All food & drink purchases brought home • Control categories (confectionary, toiletries)
• Interrupted time series analysis
• 2y before to 2y after SDIL announcement (n=208 data points) • Purchases per household per week
• L of drinks; kg of confectionary; packs of shampoo • Adjusted for: autocorrelation, January, December, Christmas
week, Easter week, average monthly temperature
MRC Epidemiology Unit
Work package 3: Economic impacts on food and other industries, HM Treasury, health and social care Lead: Prof Richard Smith Exeter University and Faculty of Public Health and Policy, LSHTM
MRC Epidemiology Unit
Stock market reaction to SDIL announcements
• Aim: to investigate the ‘market reaction’ to the SDIL via the stock market value of UK soft drink firms
• Method: Event study methodology is used to calculate the difference between the actual stock returns and the expected returns if the events did not occur.
• Announcements (events) studied: • SDIL announcements on 16th March 2016 • Release of draft legislation and consultation summary on 5th
December 2016 • Confirmation of SDIL rates on 8th March 2017
• Data: Closing stock price data of all UK-operating soft drink firms listed on London Stock Exchange (i.e. A.G. Barr, Britvic, Fever-tree and Nichols
MRC Epidemiology Unit
Work package 4: Impacts on key stakeholders Lead: Prof Martin White Centre for Diet & Activity Research, MRC Epidemiology Unit
MRC Epidemiology Unit
Impacts on key stakeholders
Purpose
• To determine the acceptability and perceived impacts of the SDIL among key stakeholders, including the public, policy makers and professionals in industry and health sectors.
Specifically, to examine
• Food industry reactions and discourse
• Political discourse and advocacy
• Media discourse
• Public reactions
MRC Epidemiology Unit
Methods – overall
Data collection • Industry trade press and print newspapers
• Factiva database, search strategy and screening of articles for relevance
• Government documents • Hand searching government websites
• Hansard (official record of Parliamentary sessions), select committee records and other key documents from relevant departments (e.g. HM Treasury, Department of Health)
• Interviews and focus groups • Telephone interviews with stakeholders from
academia, public health, civil society, government and industry and adult members of the public
• Focus groups with secondary school children Analysis • Thematic content or critical discourse analysis,
cross-sectional or longitudinal, will be used as appropriate
MRC Epidemiology Unit
Early results – Industry reactions to the announcement of the SDIL
• Purpose: To develop a detailed understanding of the evolution of industry reactions to the levy from announcement to implementation, via articles published in news media and trade press.
• Methods: Identification and screening of media and trade press articles via Factiva database using search terms and inclusion criteria
• Analysis: Longitudinal, case-based, thematic analysis of each identified industry actor
MRC Epidemiology Unit
Article characteristics and industry actors
• 526 articles were included covering the ongoing reactions from March 16th 2016 to April 6th 2018
• Nine industry actors reacting to the levy were found to contribute to the discourse on at least one occasion
• AG Barr, Britvic, Coca-Cola European Partners, Nichols, NixKix, Ribena, Tesco, Waitrose and SPAR
• Three actors dominated the discourse, throughout (~77% articles)
MRC Epidemiology Unit
SDIL evaluation: next steps
• Publish papers on impacts of announcement of levy (April 2014-March 2018)
• Update analyses from each work stream to March 2019 (one year post-implementation) and publish papers on early impact of legislation
• Update analyses to March 2020 to assess longer terms impacts of legislation (2 years post-implementation)
• Conduct modelling of medium to long term impacts of the levy on health outcomes
• Integrative analysis and synthesis of findings from WPs 1-4 to draw overall conclusions on impacts of the levy and derive generalisable learning
• Review and revise system map
MRC Epidemiology Unit
Acknowledgements The evaluation of the SDIL has been funded by NIHR Public Health Research Programme, grants 16/49/01 and 16/130/01.
MW is funded as Director of the NIHR PHR Programme.
All of the investigators receive funding from the public and charitable sectors. None of the investigators receive any funding from any commercial entities.