Estimated reduction in obesity prevalence and costs of a 20% and 30% ad valorem excise tax to sugar-sweetened beverages in Brazil: A modeling study.

BACKGROUND: The consumption of sugar-sweetened beverages (SSBs) is associated with obesity, metabolic diseases, and incremental healthcare costs. Given their health consequences, the World Health Organization (WHO) recommended that countries implement taxes on SSB. Over the last 10 years, obesity prevalence has almost doubled in Brazil, yet, in 2016, the Brazilian government cut the existing federal SSB taxes to their current 4%. Since 2022, a bill to impose a 20% tax on SSB has been under discussion in the Brazilian Senate. To simulate the potential impact of increasing taxes on SSB in Brazil, we aimed to estimate the price-elasticity of SSB and the potential impact of a new 20% or 30% excise SSB tax on consumption, obesity prevalence, and cost savings. METHODS AND FINDINGS: Using household purchases data from the Brazilian Household Budget Survey (POF) from 2017/2018, we estimated constant elasticity regressions. We used a log-log specification by income level for all beverage categories: (1) sugar-sweetened beverages; (2) alcoholic beverages; (3) unsweetened beverages; and (4) low-calorie or artificially sweetened beverages. We estimated the adult nationwide baseline intake for each beverage category using 24-h dietary recall data collected in 2017/2018. Taking group one as the taxed beverages, we applied the price and cross-price elasticities to the baseline intake data, we obtained changes in caloric intake. The caloric reduction was introduced into an individual dynamic model to estimate changes in weight and obesity prevalence. No benefits on cost savings were modeled during the first 3 years of intervention to account for the time lag in obesity cases to reduce costs. We multiplied the reduction in obesity cases during 7 years by the obesity costs per capita to predict the costs savings attributable to the sweetened beverage tax. SSB price elasticities were higher among the lowest tertile of income (-1.24) than in the highest income tertile (-1.13), and cross-price elasticities suggest SSB were weakly substituted by milk, water, and 100% fruit juices. We estimated a caloric change of -17.3 kcal/day/person under a 20% excise tax and -25.9 kcal/day/person under a 30% tax. Ten years after implementation, a 20% tax is expected to reduce obesity prevalence by 6.7%; 9.1% for a 30% tax. These reductions translate into a -2.8 million and -3.8 million obesity cases for a 20% and 30% tax, respectively, and a reduction of $US 13.3 billion and $US 17.9 billion in obesity costs over 10 years for a 20% and 30% tax, respectively. Study limitations include using a quantile distribution method to adjust self-reported baseline weight and height, which could be insufficient to correct for reporting bias; also, weight, height, and physical activity were assumed to be steady over time. CONCLUSIONS: Adding a 20% to 30% excise tax on top of Brazil's current federal tax could help to reduce the consumption of ultra-processed beverages, empty calories, and body weight while avoiding large health-related costs. Given the recent cuts to SSB taxes in Brazil, a program to revise and implement excise taxes could prove beneficial for the Brazilian population.

Association between long-term air pollution exposure and COVID-19 mortality in Latin America.

Recent studies have shown a relationship between air pollution and increased vulnerability and mortality due to COVID-19. Most of these studies have looked at developed countries. This study examines the relationship between long-term exposure to air pollution and COVID-19-related deaths in four countries of Latin America that have been highly affected by the pandemic: Brazil, Chile, Colombia, and Mexico. Our results suggest that an increase in long-term exposure of 1 µg/m3 of fine particles is associated with a 2.7 percent increase in the COVID-19 mortality rate. This relationship is found primarily in municipalities of metropolitan areas, where urban air pollution sources dominate, and air quality guidelines are usually exceeded. By focusing the analysis on Latin America, we provide a first glimpse on the role of air pollution as a risk factor for COVID-19 mortality within a context characterized by weak environmental institutions, limited health care capacity and high levels of inequality.

Direct and Indirect Costs of Diabetes in Brazil in 2016.

Background: The global economic burden of Diabetes mellitus (DM) is expected to reach US$ 745 billion in 2030. The growing prevalence of the disease, mainly type 2 diabetes, is the result of population aging, nutritional transition, which include growing rates of obesity and consumption of foods high in sugar and fat. Brazil is the fourth country in the number of patients with diabetes globally and follows the global trends, with a continuous increase in prevalence. Objectives: To estimate the economic burden of DM in Brazil, including all direct and indirect costs. Methods: We used a cost-of-illness approach to calculate the total economic burden of DM. We used official healthcare-related statistics referring to 2016. Findings: We estimated the Brazilian economic burden to reach US$ 2.15 billion in 2016, of which 70.6% are indirect costs related to premature deaths, absenteeism, and early retirement. We estimate that if the rate of growth of diabetes prevalence remains in Brazil, direct and indirect costs of diabetes will more than double by 2030 (an increase of 133.4% or 6.2% per year). Conclusion: Our results are in accordance with the literature that shows that indirect costs are more relevant in low- and middle-income countries due to poorer access to health care, which result in higher mortality rates from non-communicable diseases. However, due to the potentially underestimated prevalence of diabetes in Brazil and the lack of access to nationwide private healthcare costs, we estimate costs of diabetes in Brazil to be higher than the conservative results we found. The onset of the COVID-19 pandemic is likely to result in even greater costs than what we estimated.

Price impact of taxes on sugary drinks in Brazil.

Sugary drink consumption is an important contributor to the current global epidemic of obesity. In recent years, 50 countries or jurisdictions have implemented taxes on sugary drinks as an instrument to discourage consumption. Against the tide, Brazil reduced taxes on these beverages in 2017 and 2018. However, a recent debate - raised by the federal government - has started over taxation of sugary and alcoholic beverages (sin taxes). The effectiveness of this policy will depend on how the taxes are transferred to prices. In this sense, this paper we aim to quantify the impacts of the tax reduction on prices of sugary drinks in Brazil, and therefore to contribute to the debate by calculating the pass-through of taxes to prices of these products in the Brazilian context. We analyze the Brazilian market using a panel data of products, by brand, collected by Euromonitor from 2013 to 2018. Our results suggest that the transfer of taxes to prices depends on the firm size and the type of product, with pass-through rates ranging from 15% to 124%.

Pilot study of a two-arm non-randomized controlled cluster trial of a psychosocial intervention to improve late life depression in socioeconomically deprived areas of São Paulo, Brazil (PROACTIVE): feasibility study of a psychosocial intervention for late life depression in São Paulo.

BACKGROUND: Depression is a common and recurrent condition among older adults and is associated with poor quality of life and increased health care utilization and costs. The purpose of this pilot study was to assess the feasibility of delivering a psychosocial intervention targeting depression, and to develop the procedures to conduct a cluster randomized controlled trial among older adults registered with primary care clinics in poor neighbourhoods of São Paulo, Brazil. METHODS: We conducted a pilot study of a two-arm cluster, non-randomized controlled trial. Two primary care clinics adhering to the Family Health Strategy were allocated to either the intervention or the control arm. In the control arm, patients received enhanced usual care consisting of staff training for improved recognition and management of depression. In the intervention arm, alongside the enhanced usual care, patients received a 17-week psychosocial intervention delivered by health workers assisted with an application installed in a tablet. RESULTS: We randomly selected 579 of 2020 older adults registered in the intervention clinic to participate in the study. Among these individuals, 353 were assessed for depression and 40 (11.0%) scored at least 10 on the PHQ-9 and were therefore invited to participate. The consent rate was 33/40 (82%) with a resulting yield of 33/579 (5.7%). In the control arm, we randomly selected 320 older adults among 1482 registered in the clinic, 223 were assessed for depression and 28 (12.6%) scored 10 or above on the PHQ-9. The consent rate was 25/28 (89%), with a resulting yield of 25/320 (7.8%). Of the 33 who consented in the intervention arm, 19 (59.4%) completed all sessions. The mean PHQ-9 at follow-up (approximately 30 weeks after inclusion) were 12.3 (SD = 3.7) and 3.8 (SD = 3.9) in the control and intervention arms, respectively. Follow-up rates were 92 and 94% in control and intervention arms, respectively. CONCLUSIONS: Identification and engagement of clinics, randomization, recruitment of individuals, measures, and baseline and follow-up assessments all proved to be feasible in primary care clinics in São Paulo, Brazil. Results support the development of a definitive cluster randomized controlled trial. TRIAL REGISTRATION: This study was retrospectively registered with Registro Brasileiro de Ensaios Clínicos (ReBEC), number RBR-5nf6wd . Registered 06 August 2018.

Custos da ampliação da licença-paternidade no Brasil / Costs of the extension of the paternity leave in Brazil / Los costos de la ampliación del permiso de paternidad en Brasil

Resumo Há uma crescente literatura empírica documentando que educação e cuidado parental de qualidade estão associados com um melhor desenvolvimento emocional e cognitivo da criança. Diante disso, governos de vários países vêm promovendo mudanças nas suas leis trabalhistas, com o objetivo de dar suporte financeiro e legal (proteção do emprego) para as mães e também os pais com crianças recém-nascidas. O Brasil aprovou recentemente o Marco Legal da Primeira Infância (Lei n. 13.257/2016), que ampliou a licença-paternidade de 5 para 20 dias. Pouco se sabe, entretanto, sobre o impacto econômico desse tipo de política pública. O presente trabalho procura quantificar os custos intertemporais do custo econômico direto da extensão da licença-paternidade para o Brasil. Para isso utilizam-se microdados da Pesquisa Nacional por Amostra de Domicílios, indicadores do mercado de trabalho brasileiro e uma série de projeções populacionais para construir cenários estáticos para estimativas da probabilidade de os pais solicitarem o uso da licença. Os resultados indicam que a extensão da licença-paternidade para 20 dias tem baixo custo – cerca de R$ 100 milhões por ano no cenário mais provável, o que representa 0,01% da arrecadação federal em 2014. Conquanto a magnitude dos benefícios seja ainda desconhecida no Brasil, os resultados sugerem que esse tipo de intervenção será provavelmente custo-efetiva.

Resumen Existe una creciente documentación en la literatura empírica sobre la asociación entre la educación de calidad y el cuidado de los padres con un mejor desarrollo emocional y cognitivo de los niños. Por lo tanto, los gobiernos de varios países promueven cambios en sus leyes laborales destinadas al apoyo financiero y legal (protección del empleo) para madres y padres con hijos recién nacidos. Brasil aprobó recientemente el Marco da Primeira Infância (Ley 13.257/2016) que amplió el permiso parental de cinco a veinte días. Sin embargo, poco se sabe sobre el impacto económico de este tipo de política pública. Este artículo pretende cuantificar los costos de la extensión temporal del permiso de paternidad. A partir de datos de la Pesquisa Nacional por Amostra de Domicilios, de indicadores del mercado de trabajo y de las proyecciones de población, se estimó el costo de la extensión del permiso. Los resultados indican que el costo de esta ampliación de la licencia es bajo —cerca de R$ 100 millones por año en el escenario más probable, lo que representa 0,01% de los ingresos federales en 2014—. Aunque la magnitud de los beneficios de este tipo de intervención sea desconocida en Brasil, los resultados muestran que es probable que sea costo-efectiva.

Abstract There is a growing empirical literature documenting that quality in early education and parental care are associated with better emotional and cognitive development later in life. With this in mind, governments in several countries have changed labor laws in order to give more employment security for parents of the newborns aiming to give financial and legal support (employment protection). A law recently passed in Brazil has increased paternity leave from 5 to 20 working days of paid leave (Marco da Primeira Infância, Law 13.257/2016). Little is known, however, about the economic impacts of such a law. This paper aims at quantifying the costs of such increase in paternity leave. By utilizing the annual household survey microdata (Pesquisa Nacional por Amostra de Domicílios), some labor market indicators and a population projections series it is calculated fathers’ probability of claiming paternity benefits. Several long-range forecasts about the costs implementation produced. The results indicates that the increase in paid paternity leave, due to this change in the law, has relatively low cost – around 100 million Brazilian reais per year in the most likely scenario, an amount that is 0.01% of federal revenues in 2014. While the benefits of increasing paid paternity leave are still unknown in Brazil, the results suggest that this kind of intervention is likely to be cost-effective.

Qualidade alimentar dos brasileiros: teoria e evidência usando demanda por nutrientes / Dietary quality in Brazil : theory and evidence using demand for nutrients

Este artigo investiga a forma como a composição da dieta alimentar dos brasileiros responde a preços e dispêndios dos domicílios. Para tal, foram estimadas equações de demanda do consumidor por nutrientes pelo modelo Quadratic Almost Ideal Demand System (Quaids). A conexão entre a demanda por alimentos e por nutrientes deriva da utilidade dos alimentos por parte dos consumidores, uma vez que estes são dotados de conteúdos nutritivos. Os resultados sugerem que os nutrientes mais sensíveis a preço são: carboidratos, cálcio, ferro, colesterol e vitamina C, nutrientes básicos da dieta dos brasileiros. Com relação à renda, há fortes evidências de que a demanda por nutrientes seja sensível a mudanças nos dispêndios dos domicílios. O resultado para colesterol e lipídios preocupa, uma vez que estes nutrientes apresentam forte aumento no consumo quando há variações positivas na renda, principalmente para domicílios mais pobres.