the carrot and the stick - considering a fat tax - v6 ·...

The Carrot and the Stick-‐ Considering a Fat Tax | March 2014

1 | T h e B o w G r o u p

“The Carrot and the Stick -‐ Considering a Fat Tax”

Published by the Bow Group, June 2014

Written by Graham Godwin-‐Pearson, edited by Luke Springthorpe with foreword by Dr Sarah Wollaston MP

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Foreword In a free society we should be free to make decisions for ourselves, even bad ones, so long as they don't cause harm to others. If obesity harms only the individual does the State have any business to intervene other than to educate about the risks of a high calorie, high salt diet and to suggest healthy alternatives? Sadly education programmes have little impact on long term behaviour change. Given the sheer scale of the problem in children, a third are now leaving school overweight or obese and are highly likely to become obese adults, is it time to pilot proportionate and evidence based public health measures to help to prevent a lifetime of problems? The Bow Group have set out proposals which deserve serious consideration. To those who argue that the proposals are regressive and penalise those on low incomes, it must be said that so too does health inequality and the personal misery which accompanies the long term health consequences of obesity. Dr Sarah Wollaston MP About Dr Sarah Wollaston MP Dr Sarah Wollaston MP is a graduate of King’s College London, who practiced medicine for ten years before entering Parliament. Working as a GP, she also taught junior doctors and became an examiner for the Royal College of General Practitioners. Dr Wollaston is a fellow of the Higher Education Academy in Exeter. Now the MP for Totnes, she sits on the Health Select Committee and the Public Bill Committee for the Care Bill. About the Bow Group Founded in 1951, the Bow Group is the oldest conservative think tank in the UK and exists to publish the research of its members, stimulate policy debate through an events programme and to provide an intellectual home to conservatives. Although firmly housed in the Conservative family, the Bow Group does not take a corporate view and it represents all strands of conservative opinion. The group’s President is The Rt Hon Sir John Major KG CH and The Rt Hon Lord Howe of Aberavon Kt CH QC PC is a former Chairman and current Senior Patron. For more information, please contact Luke Springthorpe at [email protected] With many thanks to Fiona Campbell BA BANT MTI ANP CNHC and Sarah-‐Jane Sewell for their invaluable assistance with this paper.



In October 2011, Rt Hon David Cameron MP told journalists that we should consider a tax on unhealthy foods in Britain. So how realistic is it? 1 Introduction Britain is on the edge of an obesity crisis. England has the highest obesity rate in Europe and one of the highest in the developed world. More than 60% of adults and 33% of 10-‐11 year olds in this country are overweight or obese. 2,3 Perhaps most worrying of all is that the trend is set to worsen, with a 73% increase in obesity from 15m to 26m by 2030 from rates in 2011. It is clear from this that drastic action is necessary. The status quo is failing the health of our nation, and has been forecast to add anything up to £2bn a year in costs for treating medical problems resulting from obesity.4 Obesity varies widely across Britain, with levels in adults around 30% in the North East and West Midlands, according to the Association of Public Health Observatories. The national mean is 28%, double the EU average. 5

Obesity has a severe impact on our health, increasing risk of heart disease, liver disease, some cancers and type two diabetes and reducing fertility. Nationally, it has been estimated that it costs the NHS approximately £5.1bn every year, a similar amount to the cost of smoking-‐related illnesses. 6,7

The finger points at foods in our diet that are high in sugar, high in saturated fats and usually high in salt. However, whilst smoking-‐related illnesses are ‘paid for’ by high excise duties, the same cannot be said currently with regards to unhealthy foods.



A widening trend Obesity Nation, Unhealthy Nation According to the NHS, the average man needs 2,500 calories per day and the average woman 2,000 calories per day, with no more than 20g of saturated fat. 8 As many of us are only all too aware, some of the worst foods are also the most convenient. A single 330ml can of Coca Cola contains 142kcal, a cheeseburger 500kcal (25g fat), a 12” pizza contains 300kcal (10g fat), a medium serving of fries 330kcal (15g fat) and a Starbucks chocolate Frappuccino with cream 510kcal (19g fat). 9 Consuming a greater quantity of calories or fat over a period of time, combined with insufficient exercise, leads to obesity. In March 2012, then Health Secretary Rt Hon Andrew Lansley MP announced a pledge to cut 5bn calories (the equivalent of 2.1m Mars bars) from Britain’s national diet per day, signing-‐up the major supermarkets, food manufacturers and contract caterers. 10

However, obesity is still on the rise. An increase in intensive farming practices, coupled with stiff competition between supermarkets, has driven down the cost of meat and dairy products. Whereas meat was once a luxury item, it is now considered an essential part of any meal by a large proportion of the population. Similarly, cream, cheese and other dairy products are present in many meals. At the same time, improvements in technology, a shift towards the service sector and increased commuting mean that people are seeking quick, convenient food. The result is that more families are eating high-‐calorie, low-‐nutrition meals on a regular basis. Convenience foods, including microwave meals, grilled and oven-‐cooked battered meat and chips, fast food and sugary drinks are quickly becoming a staple diet of many ‘developed’ countries. The once ubiquitous fruit bowl is no longer a household essential. According to Defra, between 2009 and 2010, there was a 33% increase of children in England who included no fruit or vegetables in their diet. In the USA, a 2010 ABC television programme presented by British chef and diet activist Jamie Oliver exposed that some school-‐age children didn’t even recognise basic fruit and vegetables, including tomatoes, potatoes and cauliflower. 11 There are associated issues. One study has suggested that microwaving food destroys vitamin B12, hindering the assimilation of protein and although the body requires only a small amount of protein, it must be efficient at absorbing it. 12 In addition, the average lifestyle in Britain continues to become more and more sedentary, with children often seemingly more likely to switch on a games console than participate in physical exercise. As a nation, we need to think about other ways to encourage healthy-‐eating, discourage unhealthy foods and promote exercise. The status quo does not go nearly far enough and is failing the health of our nation.



The problem foods Saturated fats Many studies have demonstrated that foods containing saturated fats, especially processed meat and dairy, are the biggest contributors to the obesity crisis in every Western country, including ours. Meat, butter, milk, cream and cheese contribute 95% of the saturated fat in our diet and are comprised of between 2 and 9% trans-‐fatty acids. In addition to this, the protein that we receive from these foods is too acidic for the blood and neutralising this acidity causes leaching of calcium phosphate from bones, reducing mineral density. We have known for 40 years that these effects are amongst the main causes of cancer 13,14,15 and osteoporosis. 16,17,18 As such, many governments recommend the reduction of saturated fat in diets, including Britain (via the UK Food Standards Agency). 19 In 2003, the World Health Organization (WHO) and Food and Agriculture Organisation (FAO) linked saturated fats to cardiovascular risk. 20 In fact, research published in 2011 suggests that pregnant mothers consuming high-‐fat diets can pass on a preference for junk food to their foetuses. 21 In Gary Yourofsky’s world-‐renowned lecture on the culture of consumption, he states that societies and religions that have successfully promoted healthier diets note much lower overall rates of obesity, cancer and osteoporosis. 22 In 2003, American documentary filmmaker Morgan Spurlock filmed himself eating fast food and nothing else for 30 days, consuming twice the USDA-‐recommended calorie intake. During the filming, he gained 11kg, suffering liver dysfunction and depression along the way. Since then, a number of television shows have been commissioned in Britain, showing participants how poor their diet is and encouraging people to eat more healthily. Embarrassing Fat Bodies, Supersize vs Superskinny, Honey We’re Killing the Kids, The Food Hospital and others show us how not to eat, while Jamie Oliver, Heston Blumenthal, Hugh Fearnley-‐Whittingstall et al try to share healthy cooking and eating habits. Contrary to what one might think about the behaviour changing effects of the media, obesity rates continue to worsen. Perhaps this can be attributed to the huge advertising power of producers, who counter commissioned healthy-‐eating television programmes with commercials for unhealthy foods. There are other issues with these foods. Consumption of meat and dairy contribute a great deal to greenhouse gas emissions approximately 19% of the total. According to the UN, reducing consumption of these foods by just 10% could go a long way towards meeting Britain’s environmental targets. 23 Producing meat and dairy is resource-‐hungry. In June 2013, the International Development Committee of MPs called for the UK to reduce meat consumption, due to the increasing pressure on global food supplies. 24

“ Meat consumption is just as dangerous to public health as tobacco use... It’s time we looked into holding the meat producers and fast-‐food outlets legally accountable. Neal Barnard George Washington University



Other foods While meat and dairy are the primary concern, other sources of high levels of saturated fats include cakes, pastries, biscuits and processed frozen foods such as chips. Any tax on unhealthy foods would need to include many of these, according to British scientists, otherwise a reduction in saturated fat intake could lead to an increase in salt or sugar consumption. 25 Soft Drinks High in sugar, fizzy drinks can cause a range of health problems. Aside from the high calorific values, they have been blamed as the main cause of increased tooth erosion in teenagers. A 2004 study of 10,000 children by the British Dental Journal found that more than two-‐thirds of 12-‐year-‐olds and 92% of 14-‐year-‐olds consume fizzy drinks. Drinking four glasses a day could increase the risk of tooth erosion by 252% in 12-‐year-‐olds and 513% in 14-‐year-‐olds. 26 The phosphorous in fizzy drinks also leaches calcium from bones, contributing to osteoporosis later in life. Small amounts of phosphorous are important for health, but too much can lead to increased risk of cardiovascular disease. 27

Scientists and governments have long known that sugary drinks are unhealthy – leaving a tooth or penny in a glass of cola overnight has been a popular science homework experiment for decades. Despite this, the soft drink giant Coca-‐Cola is Britain’s biggest brand, with sales of £1.1bn in 2010-‐11 (around 2.58bn cans across the company’s portfolio). 28 Worldwide, 1.7bn servings of cola are dished up every single day. 29 In May 2013, Coca-‐Cola announced that it had already launched a worldwide anti-‐obesity campaign, following the roll-‐out of TV ads starting in the USA, promoting clear calorie labelling and low-‐calorie options. 30 In the UK in January 2013, GlaxoSmithKline signed-‐up to a new DoH initiative, led by Jeremy Hunt, to reduce the amount of sugar in its Lucozade and Ribena brands by up to 10% (though these brands are no longer owned by Glaxo, it is hoped new owners Suntory remain committed to this pledge). AG Barr (makers of IrnBru) has pledged to reduce calorific content by 5% and J2O is introducing new flavours in a slimmer can (with 10% fewer calories than the standard 275ml). 31 Reducing the sugar in any drink by more than 10% will alter the taste and therefore affect sales, so it is understandable why manufacturers are protective of their brands and recipes and as such are reluctant to go further. But will 10% across the billions of soft drinks sold in a year have dentists twiddling their thumbs, or contribute to Lansley’s 5bn fewer calories?



The options Seeking to affect pricing While other countries have imposed specific, new levies on the aforementioned unhealthy foods and it has even been suggested that the NHS should charge for treatment of obesity, an obvious consideration for improvement in a national diet is to charge at the point of purchase either by incorporating the relevant foods with the Value Added Tax regime or even subjecting them to an excise tax in addition to VAT. Many unhealthy foods are considered staple and do not attract VAT, but with improvements in the scientific knowledge of the negative effects of these foods, there is a case to revisit these ratings. Meat and poultry is currently zero-‐rated for VAT, as are milk and flavoured milk drinks, butter, cheese and cream. Currently, cakes have a zero VAT rating, even those with large amounts of cream, such as éclairs. Chocolate bars however, are standard-‐rated. Bizarrely, biscuits covered or partly covered with chocolate accrue standard VAT, whereas those with chocolate pressed in prior to baking are zero-‐rated. Frozen or frozen convenience foods (designed to be reheated at home) are zero-‐rated. Adding a levy of some sort at 20% to these foods could have a significant impact on obesity nationwide. Furthermore, there is evidence of precedent -‐ it has been suggested that increasing price has had an effect on consumption of tobacco; with studies suggesting a 10% increase in the price of cigarettes reduces cigarette consumption by 3 – 5%. 32

What’s more, the evidence from taxes on smoking is that young people are particularly sensitive to price increases. As such, the effect of raising prices may also encourage a diversification of the dietary choices being made by semi-‐autonomous adolescents who are just beginning to take responsibility for a greater portion of their dietary requirements. 33 Sugary and carbonated drinks, including cola, lemonade, cordials, squashes and fruit juice in cartons already attract VAT though, so it’s clear that this isn’t a catchall solution. Elsewhere in the world, tougher measures are being considered. In March 2013, New York mayor Michael Bloomberg attempted to ban ‘supersize’ sugary drinks from the city’s restaurants and entertainment venues. Although a judge blocked the move, Coca Cola’s revenues have subsequently dropped. 34

Alternatively, an excise duty could be applied. Experience in the US suggests that a 35% tax on sweetened drinks led to a 26% drop in sales, which would achieve the desired effect of reducing consumption enough to achieve a positive outcome for health (based on a study for the BMJ by Oxford Professors, readable at http://www.bmj.com/content/344/bmj.e2931).



Difficulties in changing attitudes through education Concurrently, there is a clear necessity to promote food types that provide nutrition without adversely affecting health. There’s a perception that eating healthily is more expensive and while it’s true that organic ingredients do cost more, our natural staples do not. For example, traditional, British crops such as potatoes, carrots, apples and turnips are healthy and inexpensive. The presence of other raw vegetables, such as onions and garlic in the fridge or larder cupboard can, in some cases, help to prompt people to cook healthy meals from scratch. Other wholefoods including nuts, seeds and pulses, couscous and quinoa, are popular in the developing world, because they provide palatable, healthy sources of protein and unsaturated fat, in effect replacing the unhealthy alternatives upon which we too often rely. It is also desirable to make local, seasonal and where possible, organic, foods more accessible, while concurrently reducing the appeal of highly processed and unhealthy foods. Ultimately, however, when nudging the public towards a change in behaviour, education is key but difficult to achieve and requires a long-‐term change. School children should learn about the difference between saturated and unsaturated fat, not at GCSE level, but much younger and compulsorily. Households also need information at their fingertips – quick, easy, healthy recipes that can replace microwave meals and takeaways. However, whilst there are already TV campaigns promoting healthy eating, a wider range of ad campaigns is needed to target specific demographic groups, including children, families, students and pensioners. Given that research suggests there is only a small impact of TV advertising campaigns on smoking rates 34, there is little reason to suspect that it would be significantly more successful in the case of healthy eating. What’s more, there is evidence that suggested intervention through media campaigns needs to be repetitive and also only has a noticeable effect on one off, episodic choices such as seeking vaccination or screening. 35 It is far less effective at changing habitual choices such as food choice and smoking, which suggests that influencing the price mechanism may be the best option to bring about the necessary quick change in choices. That said, it may help if the campaigns become smarter. The big manufacturers know their audience and routinely target them with clever advertising campaigns; the only way to counter this will be to employ similarly effective advertising; yet this would require proper resourcing. Food technology taught in schools should also move away from teaching aspects such as packaging and design and place maximum emphasis on the nutritional qualities of various food types. Food labelling can also play an important part. Just as tobacco companies were compelled to alert shoppers to the dangers of smoking on packets, so the worst offending foods could also be labelled prominently to alert the consumer effectively.

“ I am seeing more and more kids with breathing difficulties because of their weight, obesity-‐related problems like diabetes, heart diseases and asthma. Prof David Haslam GP Chairman of the National Obesity Forum



Considering a Fat Tax The stick Despite the importance of effective education on nutrition, studies have shown that eating behaviour is more likely to be influenced by price than nutritional education. 36 A US study showed that increasing the price of sugary drinks by 1¢ per ounce (approx. 8p on a can of fizzy drink) could reduce consumption by 25%. 37 Another study, focussing on pizza and fizzy drinks, has shown that increasing the price of these goods by 10% would reduce consumption of 7-‐12%. 38 In addition to this, a study of 5,115 young adults between 1986 and 2006 by scientists predicted that an 18% tax could reduce calorie intake by 56kcal per person per day, equivalent to 2kg per year. 39

The importance of intervening on pricing is underscored by the fact that a healthy meal plan for a family of four would cost almost double that of an unhealthy meal plan. This is based on realistic assumptions of a typical working family of four opting for ready to eat options for comparable brands, with the unhealthy option coming in at a much cheaper £76.50 against £144.12 for a healthy shop with the unhealthy option having 364% the daily recommended intake of fat.

Above: Illustration of a healthy meal plan for a family of four, totalling £144.12



Above: Illustration of an unhealthy meal plan for a family of four, totalling £76.50 That said, a fat tax is increasingly being seen by other fellow OECD countries as one of the few effective tools left to employ in their battle to avert an obesity crisis. Indeed, several countries have tried fat taxes: Denmark In Oct 2011, Denmark’s new government introduced a €2.15 levy on each kg of saturated fat in food. Butter, cheese, meat, pizza and processed food with more than 2.3% saturated fat were targeted. It also planned a tax on sugar. In Nov 2012, it was axed, the Government citing cross-‐border trading, inflated food prices, bureaucratic hassle and little change to obesity rates. 40 However, with just a year in operation, it is unlikely that any significant change will have been noticed with obesity levels. As any dieter knows, it’s harder to lose weight than to gain it. After all, it took Morgan Spurlock 14 months on a detox diet to return to his normal weight. The more likely reason for Denmark scrapping its tax was political. The Government came under intense pressure from retailers and manufacturers and lost trade to Sweden and Germany. The country already had one of the highest food taxes – a uniform 25%. Crucially, the government didn’t use the €159m revenue to encourage healthier eating, so from the consumer’s point of view, it was another way to fill government coffers. Hungary and others



In September 2011, Hungary introduced a tax on foods high in salt, sugar, carbohydrates and caffeine. Hungarians pay a 10 forint (€0.037) tax on these foods. 41 Opponents says that Hungarians on lower incomes have been discriminated against, as the cheapest foods on which they rely have increased in price disproportionately, especially when combined with the rising costs of commodities such as wheat and sugar. France has introduced a tax on sweetened drinks and Peru and Ireland are both likely to trial similar fat taxes in the future. There have been calls for the same in Indonesia. 42 British academics led by Dr Oliver Mytton and Dr Mike Rayner from the Department of Public Health at Oxford University claim that to cut consumption by enough to reduce obesity and other diet-‐related diets the price of unhealthy food and drinks would have to rise by around 20%. 43 44

However, using existing VAT ratings would go so far – adding VAT at the standard rate to meat, milk, cheese, butter and convenience foods such as chips and microwave meals would have a significant impact. As a first step, this would reduce the demand for these items and almost immediately have an impact on national health. Ultimately though, salty foods would also need to be singled out, as well as drinks high in sugar. Many of these foods are already taxed at 20%, so an additional levy would be required, either in the form of a super-‐VAT rate, or a license for manufacture or import – pushing up retail prices without increasing in-‐store administration. Either way, revenue from a fat tax would begin to accumulate on the day of implementation. Almost immediately, the government would be able to use revenues to make sure that every household was aware of any price increase and promote simple and cost effective ways to cook more healthily. The carrot Concurrently, increasing government subsidy for or reducing government income from healthy foods, such as fruit, vegetables, rice, lentils, couscous and nuts, combined with supermarket promotion of these goods, would help steer people away from their old, less healthy choices. It is clear to us that the Government would need to take adopt this ‘carrot’ approach simultaneously, to ensure that at the same time as being dissuaded from unhealthy foods, consumers are encouraged to choose healthier options. The most common criticism of a ‘Fat Tax’ is that is affects households on low incomes the most, but this can easily be overcome. We believe that complementing or even partitioning Universal Credits with a card or vouchers that can only be used to buy fruit and vegetables. With a little data and IT infrastructure, greengrocers and supermarkets would be able to claim the credit value back in a matter of hours after purchase. Clearly, the Government would need to work closely with major retailers to improve labelling and communication, particularly on supermarket shelves and products themselves. It’s important to ensure that retailers, suppliers, schools and service-‐providers are rewarded for their efforts and can implement the small changes required at little cost to them. The Government could also increase subsidies for local wholefood producers, organic arable farmers and local farmers’ markets, bringing greengrocers back to the High Street and reducing road miles on the average family’s weekly shop. This would be welcomed by farming bodies, but to improve the health of the nation however, the money raised must be passed-‐on to consumers, ensuring that healthy food is cheaper and more accessible. Over time, perhaps years, habits would change, people would be healthier and rates of obesity, cancer, and osteoporosis and type-‐2 diabetes would drop. The NHS would also be significantly less burdened.



Perhaps most importantly, this Government could start a change in national lifestyle for the better that would benefit generations of Britons to come. Is a fat tax compatible with conservative values? It is not in the nature of Conservative governments to increase taxes, especially to the less well off, without reducing them elsewhere. It is true that an additional tax on any food will affect most those on lower incomes. By their very nature, VAT and unit-‐based levies are regressive that will tax everyone to an equal amount regardless of income. However, it is not the case that households need be worse off, so long as any additional revenues are re-‐invested in healthy food and education. Any measurable change to the health of the nation as a result of a ‘fat tax’ is likely to take years, because the behaviour of consumers does not change overnight and the health and economic benefits of reducing average obesity levels will come extremely gradually. While it’s clear that persuading consumers to replace their burgers for sweet potatoes will ultimately reduce the burden on the NHS, this would not necessarily result in reduced healthcare budgets. For many other reasons, including an ageing population and increases in the costs of drugs, the NHS budgets are likely to continue to be ring-‐fenced or increased in real terms. The additional cash raised from a fat tax can be put to good use by promoting, incentivising and subsidising healthy eating almost straight away – a visible difference and return to healthy values that would please many Conservative voters. Assuming the fat tax works, one would anticipate the revenue generated to fall gradually over time, but concurrently the market share of healthy foods might be expected to increase, reducing prices and also the need for financial support.



Neutralising tax revenue: Offsetting with a VAT cut or income tax threshold rise In order to offset the regressive financial implications that would be inflicted from such a tax, we believe that there could be a cut in the rate of VAT. By imposing an additional 35% excise tax (in addition to VAT where it is already in place) on sales of buns, cakes & biscuits, pasty, cheese & curd, sugar, butter, chocolate, confectionary, ice cream and soft drink, we forecast that it would be possible raise either: -‐ £5.5 billion if sales remain the same (i.e. £15.776 billion, illustrated below), or -‐ £4.16 billion assuming that the desired 26% decline in sales is achieved from a smaller pool of sales of £11.9 billion. A VAT cut of 1% would cost a forecast £5.1 billion assuming consumption remained the same. This means that the tax raised could be used to fund a cut in the rate of VAT to 19%. Alternatively, it could be used to fund an increase in the personal allowance for income tax to £12,500 by April 2020 based on 2014-‐15 prices.45 ONS Study on Family Spending, 2012 Buns, cakes & biscuits £4.7 bn Pastry: £988m Cheese & curd: £2.496 bn Butter: £624m Sugar: £572 m Chocolate: £2.236 bn Confectionary: £936m Ice cream & edible ices; £728 m Soft drinks: £2.496 bn Total: £15.776 bn of sales Conclusions The key recommendations of this paper are as follows:

-‐ Add VAT to unhealthy food products that currently do not attract the levy, or

-‐ Add an excise duty of 35% on to unhealthy foodstuffs, including those high in saturated fat, salt and sugar, thereby providing a disincentive to eat unhealthily.

-‐ Consider the imposing of 35% additional tax on unhealthy foods that already attract VAT.

-‐ Hand money back to the taxpayer through either a 1% cut in VAT or a rise in the income tax threshold to £12,500.



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28. “Coca-‐Cola is Britain’s best-‐selling brand” Telegraph 12 Mar 2011, www.telegraph.co.uk/finance/newsbysector/retailandconsumer/8376460/Coca-‐Cola-‐is-‐Britains-‐best-‐selling-‐brand.html 29. “Coca-‐Cola by numbers” Coca-‐Cola website, www.coca-‐cola.co.uk/about-‐us/coca-‐cola-‐by-‐numbers.html 30. “Coca-‐Cola begins global anti-‐obesity campaign” DC Progressive 26 May 2013, dcprogressive.org/2013/05/26/coca-‐cola-‐begins-‐global-‐anti-‐obesity-‐campaign-‐nyseko 31. “Sugar and calories reduced in soft drinks” DoH 22 Jan 2013, www.dh.gov.uk/health/2013/01/soft-‐drinks 32. See, e.g., Chaloupka, FJ, “Macro-‐Social Influences: The Effects of Prices and Tobacco Control Policies on the Demand for Tobacco Products,” Nicotine and Tobacco Research 1(Suppl 1):S105-‐9, 1999; other studies at http://tigger.uic.edu/~fjc/ 33. “Higher Tobacco Taxes Can Improve Health and Raise Revenue” Center on Budget and Policy Priorities http://www.cbpp.org/cms/?fa=view&id=3978 34. “Coke loses favour among health savvy Americans” Telegraph 19 Feb 2014, http://www.telegraph.co.uk/finance/newsbysector/retailandconsumer/10647284/Coca-‐Cola-‐sales-‐fall-‐as-‐consumers-‐switch-‐to-‐healthier-‐drinks.html 35. Dominic McVey, John Stapleton (2000) “Can anti-‐smoking television advertising affect smoking behaviour? Controlled trial of the Health Education Authority for England's anti-‐smoking TV campaign” British Medical Journal. 36. Melanie A Wakefield, Barbara Loken, Robert C Hornik (7 Oct 2010), “Use of Mass Media Campaigns to change Health Behaviour”, Lancet 2010 Review, 1268 http://www.union-‐imdp.org/files/Use.of_.Mass_.Media_.Campaigns.to_.Change.Health.Behaviour.pdf 37. Horgen, K.B.; Brownell, K.D. (2002). "Comparison of price change and health message interventions in promoting healthy food choices". Health Psychology 21 (5): 505–512, psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/0278-‐6133.21.5.505 38. Brownell K, Farley T, Willett W, Popkin B, Chaloupka F, Thompson J, Thompson D, Ludwig (2009). "The Public Health and Economic Benefits of Taxing Sugar-‐Sweetened Beverages". Health Policy Report of the New England Journal of Medicine 361 (16): 1599–605, www.nejm.org/doi/full/10.1056/NEJMhpr0905723 39. Duffey, et al., Gordon-‐Larsen P, Shikany, JM, Guilkey, D, Jacobs Jr, DR, Popkin, BM (2010). "Food Price & Diet & Health Outcomes" Arch. Intern. Med. 170 (5): 420–6, archinte.jamanetwork.com/article.aspx?articleid=774511 40. “Tax soda, pizza to cut obesity, researchers say” Reuters 8 Mar 2010, www.reuters.com/article/2010/03/08/us-‐food-‐tax-‐idUSTRE6275T720100308 41. “Denmark to abolish tax on high-‐fat foods” BBC 10 Nov 2012, www.bbc.co.uk/news/world-‐europe-‐20280863 42. “Welcoming the age of disease prevention” Jakarta Post 17 Dec 2011 www.thejakartapost.com/news/2011/12/17/welcoming-‐age-‐disease-‐prevention.html 43. “Fat tax on unhealthy food must raise prices by 20% to have effect, says study” Guardian 16 May 2012, www.guardian.co.uk/society/2012/may/16/fat-‐tax-‐unhealthy-‐food-‐effect 44. Mytton O, Clarke D, Rayner M (2012) “Taxing unhealthy food and drinks to improve health”. BMJ 344:e2931, www.bmj.com/content/344/bmj.e2931 45. A. Hood, R. Joyce & D.Phillips: “Policies to Help the Low Paid”. IFS, pg 152, www.ifs.org.uk/budgets/gb2014/gb2014_ch7.pdf Further Reading T. Colin Campbell, Ph.D. and Thomas M. Campbell II, M.D., The China Study: Startling Implications for Diet, Weight Loss and Long-‐Term Health Paul Lindley et al, “Averting a Recipe For Disaster” Feb 2013, www.avertingarecipefordisaster.com/pdf/Averting_A_Recipe_For_Disaster-‐February_2012.pdf An Pan, PhD; Qi Sun, MD, ScD; Adam M. Bernstein, MD, ScD; Matthias B. Schulze, DrPH; JoAnn E. Manson, MD, DrPH; Meir J. Stampfer, MD, DrPH; Walter C. Willett, MD, DrPH; Frank B. Hu, MD, PhD (2012). “Consumption and Mortality” Arch Intern Med. 2012; 172(7):555-‐563, archinte.jamanetwork.com/article.aspx?articleid=1134845

the carrot and the stick - considering a fat tax - v6 ·...

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