Modelling the potential impact of a tax on fruit juice in South Africa: implications for the primary prevention of type 2 diabetes and health financing.

IF 1.9 Q3 NUTRITION & DIETETICS
Micheal Kofi Boachie, Karen Hofman, Susan Goldstein, Evelyn Thsehla
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引用次数: 0

Abstract

Background: South Africa is experiencing a persistent growth in non-communicable diseases. Diabetes is among the top ten causes of mortality, especially among women, which is partly driven by high levels of added sugar consumption and obesity. To reduce obesity rates and the incidence of diabetes, South Africa introduced a tax on sugar sweetened beverages (also known as the Health Promotion Levy (HPL)) in 2018. The tax is applicable to sugar-sweetened beverages but excludes 100% fruit juice. The government is currently considering extending the tax to include fruit juices. This study models the potential health and economic impact of taxing fruit juices at 20% of the retail price of one liter.

Methods: To analyze the distributional impact of the tax, this study uses extended cost-effectiveness analysis methodology. Data on price elasticities, healthcare cost, income, fruit juice consumption were sourced from the literature and representative national surveys. The potential impact of the tax on diabetes incidence, prevalence, mortality, and financial benefits were estimated for each income group (lowest, quintile 1 to highest, quintile 5).

Findings: We estimate that a 20% tax on fruit juice would avert 156,640 incident cases of type 2 diabetes mellitus over 20 years, with most disease averted occurring among the first- and fifth-income groups. Averted deaths from diabetes would average 2,000 deaths per quintile (for quintiles 1 to 4) and about 2,800 in quintile 5. The improved health resulting from averted incidence and deaths will reduce overall healthcare expenditure by R7.5 billion over 20 years, of which R2.3 billion will occur in the fifth quintile. The South African government will also save about R300 million in subsidizing diabetes-related healthcare cost as a result of prevention; and would raise R8.6 billion in tax revenues per annum. Out-of-pocket expenditure savings will be R303 million and a financial risk protection (money-metric value of insurance) of R4.6 billion over the 20-year period.

Conclusion: We conclude that an HPL that significantly raises the retail price of fruit juices would reduce consumption and diabetes-related morbidity and mortality. The tax will also provide significant financial benefits in the form of reduced healthcare costs for both government and households as well as providing financial risk protection to individuals. Health taxes are win-win policies that improve population health and generate revenue for governments to fund public health services delivery and thus improve overall health financing activities of the government. Therefore, population level disease prevention measures such as health taxes are important for achieving universal health coverage.

模拟南非果汁税的潜在影响:对 2 型糖尿病初级预防和卫生筹资的影响。
背景:南非正在经历非传染性疾病的持续增长。糖尿病是导致死亡的十大原因之一,尤其是在妇女中,其部分原因是高水平的添加糖消费和肥胖。为了降低肥胖率和糖尿病发病率,南非于 2018 年开始对含糖饮料征税(也称为健康促进税(HPL))。该税适用于含糖饮料,但不包括 100% 果汁。政府目前正在考虑扩大征税范围,将果汁也包括在内。本研究模拟了按一升果汁零售价的 20% 征税对健康和经济的潜在影响:为了分析征税对分配的影响,本研究采用了扩展的成本效益分析方法。有关价格弹性、医疗成本、收入、果汁消费量的数据均来自文献和具有代表性的全国性调查。对每个收入组(最低的五分位数 1 到最高的五分位数 5)征税对糖尿病发病率、患病率、死亡率和经济效益的潜在影响进行了估算:我们估计,征收 20% 的果汁税将在 20 年内避免 156 640 例 2 型糖尿病病例,其中第一和第五收入组避免的病例最多。平均每个五等分层(五等分层 1 至 4)可避免 2,000 例糖尿病死亡,五等分层 5 可避免约 2,800 例糖尿病死亡。因避免发病和死亡而改善的健康状况将在 20 年内减少 75 亿兰特的总体医疗支出,其中 23 亿兰特将用于五等分层的第五层。南非政府还将因预防糖尿病而节省约 3 亿兰特的糖尿病相关医疗费用补贴,并将每年增加 86 亿兰特的税收。自付支出将节省 3.03 亿兰特,20 年间的财务风险保护(保险的货币计量价值)将达到 46 亿兰特:我们的结论是,大幅提高果汁零售价格的 HPL 将减少果汁消费,降低与糖尿病相关的发病率和死亡率。该税收还将为政府和家庭带来显著的经济效益,即降低医疗成本,并为个人提供财务风险保护。健康税是一项双赢政策,既能改善人口健康,又能为政府创造收入,为提供公共卫生服务提供资金,从而改善政府的整体卫生筹资活动。因此,健康税等人口层面的疾病预防措施对于实现全民医保非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Nutrition
BMC Nutrition Medicine-Public Health, Environmental and Occupational Health
CiteScore
2.80
自引率
0.00%
发文量
131
审稿时长
15 weeks
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