The ethics of excise taxes on sugar-sweetened beverages
The ethics of excise taxes on sugar-sweetened beverages
复制标题
DOI：
10.1016/j.physbeh.2020.113105
复制
发表时间：
2020-10-15
影响因子：
2.9
通讯作者：
Falbe, Jennifer
中科院分区：
文献类型：
--
作者：
Falbe, Jennifer
加糖饮料税已成为促进健康和资助受饮食相关疾病影响最严重的社区投资的优先政策。目前，美国有8个司法管辖区和40多个国家实施了SSB税。评估表明，这些政策减少了SSB的消费和购买，同时增加了用于资助公共卫生，教育和公平的收入。然而，很少有人分析SSB征税的道德考虑。使用一个框架来评估公共卫生干预的道德，本文认为SSB消费税的道德方面：身体健康，心理健康，平等，知情选择，自由，社会和文化价值观，责任。现有证据表明，对制造商和分销商征收SSB消费税有很强的道德理由。SSB消费税减少了SSB的消费和购买，预计将有意义地减少肥胖和饮食相关的发病率和死亡率。由于SSB税是特定于产品及其制造商的，因此它们不太可能通过侮辱超重的人来损害心理健康。SSB消费税应导致更大的平等，因为健康和社会福利是渐进的（即，低收入个人可能从税收中获得最大的好处，如果税收用于保健和社会公平，情况就更是如此）。与此同时，如果分销商提高SSB价格以应对税收，那么消费者的平均成本负担将是最小的累退。关于自由，SSB税并没有消除购买SSB的选择，但如果SSB分销商提高SSB价格，继续购买相同数量的SSB就会变得更加昂贵。与此同时，税收通过为饮用水供应提供资金来扩大饮料选择，并促使行业扩大不加糖饮料和含糖较少的SSB的供应。此外，通过避免健康状况不佳，SSB税应该扩大追求个人目标的总体自由。知情选择可以通过看到更高的SSB货架价格（这表明饮料含有添加糖）和接触由税收资助的营养教育来促进。SSB征税不太可能对社会或文化价值观产生负面影响，因为征税不会消除特殊场合的SSB，而且SSB不是传统饮食的主食。最后，国家卫生局的税收以反映工业对肥胖的贡献和预防饮食相关疾病所需的多部门解决方案的方式确定了健康责任。
Sugar-sweetened beverage (SSB) taxation has emerged as a priority policy for promoting health and funding investments in communities most affected by diet-related disease. There are now 8 U.S. jurisdictions and over 40 countries that have implemented SSB taxes. Evaluations show that these policies reduce SSB consumption and purchasing while raising revenues to fund public health, education, and equity. However, there have been few analyses of the ethical considerations of SSB taxation. Using a framework for evaluating the ethics of public health interventions, this paper considers the ethical aspects of SSB excise taxes with respect to: physical health, psychosocial well-being, equality, informed choice, liberty, social and cultural values, and responsibility. Available evidence suggests there is a strong ethical case for levying SSB excise taxes on manufacturers and distributors. SSB excise taxes reduce consumption and purchasing of SSBs and are expected to meaningfully reduce obesity and diet-related morbidity and mortality. Because SSB taxes are specific to a product and its manufacturers, they are unlikely to harm psychosocial health by stigmatizing people who are overweight. SSB excise taxes should lead to greater equality because the health and social benefits are progressive (i.e., low-income individuals are likely to accrue the largest benefits from the tax, even more so when revenues are spent on health and social equity). Meanwhile, the average consumer cost burden that would result if distributors raise SSB prices in reponse to the tax is minimally regressive. Regarding liberty, SSB taxes do not eliminate the option of buying SSBs, but if SSB distributors raise SSB prices, it becomes somewhat more expensive to continue purchasing the same amount of SSBs. Meanwhile, the taxes expand beverage options by funding drinking water availability and prompting industry to expand offerings of unsweetened drinks and SSBs containing less sugar. Furthermore, by averting poor health, SSB taxes should expand overall freedom to pursue one's goals. Informed choice could be facilitated by seeing a higher SSB shelf price (which indicates a drink contains added sugar) and exposure to nutrition education funded with tax revenues. SSB taxation is unlikely to negatively interfere with social or cultural values because taxation would not eliminate having SSBs for special occasions, and SSBs are not a staple of traditional diets. Lastly, SSB taxation attributes responsibility for health in a manner that reflects industry's contribution to obesity and the multisectoral solutions that are needed to prevent diet-related disease.