Cost-Effectiveness of a US National Sugar-Sweetened Beverage Tax With a Multistakeholder Approach: Who Pays and Who Benefits.

OBJECTIVES: To estimate the health impact and cost-effectiveness of a national penny-per-ounce sugar-sweetened beverage (SSB) tax, overall and with stratified costs and benefits for 9 distinct stakeholder groups. METHODS: We used a validated microsimulation model (CVD PREDICT) to estimate cardiovascular disease reductions, quality-adjusted life years gained, and cost-effectiveness for US adults aged 35 to 85 years, evaluating full and partial consumer price pass-through. RESULTS: From health care and societal perspectives, the SSB tax was highly cost-saving. When we evaluated health gains, taxes paid, and out-of-pocket health care savings for 6 distinct consumer categories, incremental cost-effectiveness ratios ranged from $20 247 to $42 662 per quality-adjusted life year for 100% price pass-through (incremental cost-effectiveness ratios similar with 50% pass-through). For the beverage industry, net costs were $0.92 billion with 100% pass-through (largely tax-implementation costs) and $49.75 billion with 50% pass-through (largely because of partial industry coverage of the tax). For government, the SSB tax positively affected both tax revenues and health care cost savings. CONCLUSIONS: This stratified analysis improves on unitary approaches, illuminating distinct costs and benefits for stakeholders with political influence over SSB tax decisions.

KEEPING SODA IN SNAP: Understanding the Other Iron Triangle.

Participants in SNAP have always been allowed to use their taxpayer-funded benefit to purchase Sugar Sweetened Beverages (SSBs). Despite an acute public health crisis surrounding the consumption of unhealthy products including SSBs, especially among the low-income citizens who also qualify for SNAP benefits, this policy has yet to be changed. Interviews with policy participants in Washington, D.C., reveal that change is being blocked by a culture of "personal responsibility" in America, plus three specific political forces: corporate lobbying primarily by the beverage and food retail industries; a desire by liberals to defend SNAP as income support for the poor even if nutrition outcomes are sub-optimal; and institutional inertia within the Department of Agriculture and the agricultural committees of Congress. In the 2018 farm bill debate, this "iron triangle" of bipartisan resistance to change was strong enough to block even a pilot study of SSB restrictions in SNAP.

Viewpoint: Can U.S. local soda taxes continue to spread?

Taxes to reduce the consumption of sugar-sweetened beverages (SSBs) such as soda drinks have been endorsed by the World Health Organization and are now in place in France, Hungary, and Mexico, and scheduled for Portugal, South Africa, and Great Britain. Such taxes have so far been impossible to enact in the United States at the state or federal level, but since 2014 seven local jurisdictions have put them in place. Three necessary conditions for local political enactment emerge from this recent experience: Democratic Party dominance, external financial support for pro-tax advocates, and a political message appropriate to the process (public health for ballot issues; budget revenue for city council votes). Roughly 40 percent of Americans live within local jurisdictions where the Democratic Party dominates, so room exists for local SSB taxes to continue spreading.

The cost of not adopting new agricultural food biotechnologies.

Achieving the United Nations (UN) Sustainable Development Goals (SDGs) will require additional innovation investments and increased adoption of resulting technologies. This will be particularly important for improving food security, crop nutrient availability, and sustainability. This article presents some of the global costs of not adopting genetically modified (GM) crops and genome editing breeding.

Food Systems as Drivers of Optimal Nutrition and Health: Complexities and Opportunities for Research and Implementation.

The Sustainable Development Goals (SDGs) are intricately linked to food systems. Addressing challenges in food systems is key to meeting the SDGs in Africa and South Asia, where undernutrition and micronutrient deficiencies persist, alongside increased nutrition transition, overweight and obesity, and related chronic diseases. Suboptimal diets are a key risk factor for mortality and 3 billion people cannot afford a healthy diet; in addition, food systems are not prioritizing environmental sustainability. Optimizing food systems and increasing agricultural productivity beyond calories, to nutrient-rich vegetables and fruits, legumes, and livestock, and sustainable fishing, are required. Strengthening of research around food systems-on pathways, value chains, and development and validation of metrics of diet quality-is required. The development of new technology in crop management and pest control and addressing natural resource degradation is key. Engaging with the public and private sectors, outreach to donors and policymakers, and strengthening cross-disciplinary collaborations are imperative to improving food systems.

Harnessing University Strengths in Multisectoral Collaborations for Planetary Health.

Although significant achievements in human health have been made globally, progress has been made possible, in part, through unconstrained use of natural resources. As the health of our planet worsens, human health is also endangered. Scholars and policymakers from diverse disciplines highlighted complex, multisectoral approaches for addressing poor dietary intake, over- and undernutrition, and chronic diseases in sub-Saharan Africa at the Agriculture, Nutrition, Health, and the Environment in Africa Conference held at Harvard University on 6-7 November 2017. A planetary health approach to addressing these challenges offers a unique opportunity to advance solutions for environmental and social factors that influence agriculture, nutrition, and overall health in the larger context of rapid population growth and transitions in food systems and livelihoods. This paper outlines 3 key avenues for universities to promote science at the intersection of public health and the environment in sub-Saharan Africa.

A dubious success: the NGO campaign against GMOs.

Genetically engineered agricultural crops are widely grown for animal feed (yellow corn, soybean meal) and for industrial purposes (such as cotton for fabric, or yellow corn for ethanol), but almost nobody grows GMO food staple crops. The only GMO food staple crop planted anywhere is white maize, and only in one country--the Republic of South Africa. It has been two decades now since GMO crops were first planted commercially, yet it is still not legal anywhere to plant GMO wheat or GMO rice. When it comes to GMO food crops, anti-GMO campaigners have thus won a remarkable yet dubious victory. They have not prevented rich countries from using GMO animal feed or GMO cotton, yet farmers and consumers in poor countries need increased productivity for food crops, not animal feed or industrial crops. Today's de facto global ban on GMO food crops therefore looks suspiciously like an outcome designed by the rich and for the rich, with little regard for the interests of the poor.

GMO foods and crops: Africa's choice.

There is a scientific consensus, even in Europe, that the GMO foods and crops currently on the market have brought no documented new risks either to human health or to the environment. Europe has decided to stifle the use of this new technology, not because of the presence of risks, but because of the absence so far of direct benefits to most Europeans. Farmers in Europe are few in number, and they are highly productive even without GMOs. In Africa, by contrast, 60% of all citizens are still farmers and they are not yet highly productive. For Africa, the choice to stifle new technology with European-style regulations carries a much higher cost.