Jensen Henning Tarp, Keogh-Brown Marcus R, Shankar Bhavani, Aekplakorn Wichai, Basu Sanjay, Cuevas Soledad, Dangour Alan D, Gheewala Shabbir H, Green Rosemary, Joy Edward, Rojroongwasinkul Nipa, Thaiprasert Nalitra, Smith Richard D
London School of Hygiene & Tropical Medicine, UK.
University of Copenhagen, Denmark.
SSM Popul Health. 2019 Jul 31;9:100435. doi: 10.1016/j.ssmph.2019.100435. eCollection 2019 Dec.
United Nations (UN) member states have, since 2011, worked to address the emerging global NCD crisis, but progress has, so far, been insufficient. Food trade policy is recognised to have the potential to impact certain major diet-related health and environmental outcomes. We study the potential for using import tariff protection as a health and environmental policy instrument. Specifically, we apply a rigorous and consistent Macroeconomic-Environmental-Demographic-health (MED-health) simulation model framework to study fiscal food policy import tariffs and dietary change in Thailand over the future 20 year period 2016-2035. We find that the existing Thai tariff structure, by lowering imports, lowers agricultural Land Use Change (LUC)-related GHG emissions and protects against cholesterol-related cardiovascular disease (CVD). This confirms previous evidence that food trade, measured by import shares of food expenditures and caloric intakes, is correlated with unhealthy eating and adverse health outcomes among importing country populations. A continued drive towards tariff liberalization and economic efficiency in Thailand may therefore come at the expense of reduced health and environmental sustainability of food consumption and production systems. Due to large efficiency losses, the existing tariff structure is, however, not cost-effective as an environmental or health policy instrument. However, additional simulations confirm that stylized 30% food sector import tariffs generally improve nutritional, clinical health, demographic, and environmental indicators across the board. We also find that diet-related health improvements can go hand-in-hand with increased Saturated Fatty Acid (SFA) intakes. Despite limited cost-effectiveness, policy makers from Thailand and abroad, including WHO, would therefore be well advised to consider targeted fiscal food policy tariffs as a potential intervention to maintain combined health and environmental sustainability, and to reconsider the specification of WHO dietary guidelines with their focus on SFA intake (rather than composition of fatty acid intake) targets.
自2011年以来，联合国成员国一直致力于应对新出现的全球非传染性疾病危机，但迄今为止，进展仍显不足。人们认识到，食品贸易政策有可能影响某些与饮食相关的主要健康和环境结果。我们研究了将进口关税保护用作健康和环境政策工具的潜力。具体而言，我们应用一个严谨且一致的宏观经济-环境-人口健康（MED-健康）模拟模型框架，来研究2016年至2035年未来20年期间泰国的财政食品政策进口关税和饮食变化。我们发现，泰国现有关税结构通过降低进口量，减少了与农业土地利用变化（LUC）相关的温室气体排放，并预防了与胆固醇相关的心血管疾病（CVD）。这证实了先前的证据，即按食品支出和热量摄入的进口份额衡量的食品贸易，与进口国人口的不健康饮食和不良健康结果相关。因此，泰国持续推动关税自由化和经济效率提升，可能会以牺牲食品消费和生产系统的健康与环境可持续性降低为代价。然而，由于效率损失巨大，现有关税结构作为一种环境或健康政策工具并不具有成本效益。不过，额外的模拟结果证实，程式化的30%食品部门进口关税总体上能全面改善营养、临床健康、人口和环境指标。我们还发现，与饮食相关的健康改善可以与饱和脂肪酸（SFA）摄入量的增加同时出现。尽管成本效益有限，但泰国及包括世界卫生组织（WHO）在内的其他国家的政策制定者，因此最好考虑将有针对性的财政食品政策关税作为一种潜在干预措施，以维持健康与环境的综合可持续性，并重新审视WHO饮食指南中以SFA摄入量（而非脂肪酸摄入构成）为重点的目标设定。
