Saxena Akshar, Stacey Nicholas, Puech Paula Del Ray, Mudara Caroline, Hofman Karen, Verguet Stéphane
Economics, Nanyang Technological University, Singapore, Singapore.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
BMJ Glob Health. 2019 Aug 21;4(4):e001317. doi: 10.1136/bmjgh-2018-001317. eCollection 2019.
Facing increasing obesity prevalence and obesity-related disease burden, South Africa has devised an obesity prevention strategy that includes a recently implemented tax on the sugar content of sugar-sweetened beverages (SSB). We assess the potential distributional impact (across socioeconomic groups) of this tax on type 2 diabetes mellitus (T2DM) incidence and associated mortality and its financial burden on households.
We conducted an extended cost-effectiveness analysis of the new 10% tax on SSBs in South Africa, and estimated: the averted premature deaths related to T2DM, the financial benefits to households (out-of-pocket (OOP) medical costs and indirect costs due to productivity losses averted), the increased government tax revenues and healthcare savings for the government, all across income quintiles.
A 10% SSB tax increase would avert an estimated 8000 T2DM-related premature deaths over 20 years, with most deaths averted among the third and fourth income quintiles. The government would save about South African rand (ZAR) 2 billion (US$140 million) in subsidised healthcare over 20 years; and would raise ZAR6 billion (US$450 million) in tax revenues per annum. The bottom two quintiles would bear the smallest tax burden increase (36% of the additional taxes). The bottom two income quintiles would also have the lowest savings in OOP payments due to significant subsidisation provided by government healthcare. Lastly, an estimated 32 000 T2DM-related cases of catastrophic expenditures and 12 000 cases of poverty would be averted.
SSB taxation would have a substantial distributional impact on obesity-related premature deaths, cost savings to the government and the financial outcomes of South Africa's population.
面对日益增长的肥胖患病率和与肥胖相关的疾病负担，南非制定了一项肥胖预防战略，其中包括最近对含糖饮料（SSB）的含糖量实施的税收政策。我们评估了这项税收对2型糖尿病（T2DM）发病率、相关死亡率的潜在分配影响（ across socioeconomic groups）及其对家庭的经济负担。
我们对南非新的10%含糖饮料税进行了扩展的成本效益分析，并估计了：与T2DM相关的避免过早死亡人数、家庭的经济收益（自付医疗费用和因避免生产力损失而产生的间接成本）、政府税收增加额以及政府的医疗保健节省额，涵盖所有收入五分位数。
含糖饮料税提高10%预计在20年内可避免约8000例与T2DM相关的过早死亡，其中大部分死亡避免发生在第三和第四收入五分位数人群中。政府在20年内将在补贴医疗保健方面节省约20亿南非兰特（1.4亿美元）；每年将增加60亿南非兰特（4.5亿美元）的税收收入。收入最低的两个五分位数人群承担的税收负担增加最少（占新增税收的36%）。由于政府医疗保健提供了大量补贴，收入最低的两个五分位数人群在自付费用方面的节省也最低。最后，预计可避免约32000例与T2DM相关的灾难性支出病例和12000例贫困病例。
对含糖饮料征税将对与肥胖相关的过早死亡、政府成本节省以及南非人口的经济状况产生重大的分配影响。
