Nutrition-related health taxes: setting expectations.
Nutrition-related health taxes: setting expectations.
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DOI：
10.1016/s2213-8587(21)00325-9
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
Kaufman JS
中科院分区：
文献类型：
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作者：
Miranda JJ;Thow AM;Cárdenas MK;Corvalán C;Barrientos-Gutiérrez T;Kaufman JS
评论94 www.我的天使com/diabetes-endocrinology 2022年2月10日的问题是行业的适应性反应。由于只有在消费发生根本变化时才能观察到税收效应，因此行业的反应可能足以抵消预期的影响，从而导致税收无效。这反过来又可以用来表明干预措施不起作用，而真实的问题可能是干预措施是否足够强大，足以将局面改变到工业无法缓冲的地步，此外，尽管税收可能特别引人注目和有争议，但它只是预防肥胖和与营养有关的非传染性疾病的几种干预措施之一。人们对基于全面营养成分分析模型的前包装标签政策的兴趣正在迅速增长。将标签和税收干预措施联系起来，以加强两者的影响，这方面有很大的潜力;例如，使用FOP标签或相同的基本营养成分分析模式，作为对不健康食品广泛征税的基础。8值得注意的是，本评论中提出的许多问题也适用于评价FOP标签干预措施，并适用于任何复杂的全民公共卫生干预措施。重要的是要认识到，在任何此类干预下，不同背景下的不同政策可能并不相同。在FOP标签政策的情况下，警告标签具有不同的文本或阈值，并且在不同的空间（例如学校，媒体）中是强制性的。FOP标签的一些影响与它与其他政策交织在一起的方式有关，例如，包括在学校和广告渠道禁止带有FOP标签的产品，与营养有关的健康税可能非常有效。今后，更多的国家将参与类似的举措，以应对肥胖和饮食相关疾病的全球流行。在这里，我们提出了几个问题，以批判性地告知如何随着时间的推移生成和总结证据，而不是草率行事，声称税收有效或无效。与营养相关的健康税的评估很可能不适合在传统的随机对照试验中进行研究。公共卫生和经济学领域必须超越对RCT作为最佳证据来源的依赖，并继续提供强有力的方法，9包括自然实验和准实验方法，以及有利于在现实世界情景中对这些政策进行理论驱动评估的框架，10
Comment94 www. thelancet. com/diabetes-endocrinology Vol 10 February 2022 issue is the adaptive response by industry. As the tax effects can be observed only if there is an underlying change in consumption, industry responses can be strong enough to neutralise the anticipated effects, therefore resulting in the tax being ineffective. This can, in turn, be used to suggest that interventions do not work, when the real question could be whether the intervention was strong enough to change the landscape to a point in which industry was unable to buffer it. In addition, although taxation might be particularly visible and controversial, it is just one of several interventions for the prevention of obesity and nutritionrelated non-communicable diseases. Interest in frontof-pack (FOP) labelling policies, based on comprehensive nutrient profiling models, is rapidly growing. There is great potential for linking labelling and tax interventions to enhance the impact of both; for example, using the FOP label or the same underlying nutrient profiling model as the basis for broad-based taxation of unhealthy foods. 8 Notably, many of the issues raised in this Comment also apply in the evaluation of FOP labelling interventions and, for that matter, to any complex population-wide public health intervention. It is important to recognise that, with any such intervention, different policies in different contexts might not be identical. In the case of FOP labelling policies, the warning labels have, for example, different texts or threshold values, and are mandatory in different spaces (eg, schools, media). Some of the impacts of FOP labelling are related to the way it is intertwined with other policies, including, for example, the banning of products with FOP labels in schools and channels of advertisement.Nutrition-related health taxes can be very effective. In the future, many more countries will engage in similar initiatives to counter the global pandemic of obesity and diet-related conditions. Rather than jumping the gun and claiming that taxes work or do not work, here we raise several questions to critically inform how the evidence should be generated and summarised over time. The evaluation of nutrition-related health taxes will most likely not be amenable to being studied under traditional RCTs. The fields of public health and economics will have to move beyond their reliance on RCTs as the sources of best evidence, and continue providing robust methods, 9 including natural experiments and quasi-experimental methods, and frameworks that favour theory-driven evaluations of these policies in real-world scenarios, 10