Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, Hartford.
The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
JAMA Netw Open. 2022 Jun 1;5(6):e2214371. doi: 10.1001/jamanetworkopen.2022.14371.
Fiscal policy is a promising approach to incentivizing better food choices and reducing the burden of chronic disease. To inform guidelines on using fiscal policies, including taxes and subsidies, to promote health, the World Health Organization commissioned a systematic review and meta-analysis of the worldwide literature on the outcomes of such policies for food products.
To assess the outcomes of implemented food taxes and subsidies for prices, sales, consumption, and population-level diet and health.
Eight bibliographic databases were searched for peer-reviewed literature and 14 data sources along with governmental websites were searched for grey literature that were published from database inception through June 1, 2020. There were no language and setting restrictions.
Only primary studies of implemented food taxes and subsidies were considered for inclusion.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. A 3-level random-effects model was used to conduct a meta-analysis of sales and consumption outcomes of fruit and vegetable subsidies. Other outcomes were analyzed in a narrative synthesis.
Study estimates in the meta-analysis were combined using a price elasticity measure for sales and consumption outcomes. Heterogeneity was assessed using the I2 statistic and τ2. Studies varied in how diet and health were measured.
A total of 54 articles were included in the systematic review, of which 15 studies were included in the meta-analysis. Most food subsidies targeted fruits and vegetables and populations with low income, whereas the evidence on food taxes was primarily from the nonessential energy-dense food tax in Mexico. Sales of subsidized fruits and vegetables increased significantly, with an estimated price elasticity of demand of -0.59 (95% CI, -1.04 to -0.13 [P = .02]; 95% prediction interval, -2.07 to 0.90; I2 = 92.4% [95% CI, 89.0%-94.8%; P < .001]), suggesting inelastic demand. There was no significant change in the consumption of subsidized fruits and vegetables, with an estimated price elasticity of demand of -0.17 (95% CI, -0.49 to 0.15 [P = .26]; 95% prediction interval, -1.01 to 0.67; I2 = 76.2% [95% CI, 54.3%-87.6%; P < .001]). Food excise taxes were associated with higher prices and reduced sales. Evidence was limited on the differential outcomes of food taxes and subsidies across subpopulations.
Results of this systematic review and meta-analysis indicated that fruit and vegetable subsidies were associated with a moderate increase in fruit and vegetable sales. Further research is warranted to understand the implications of food taxes and subsidies for population-level consumption, diet, and health outcomes.
财政政策是激励人们选择更健康食品和减轻慢性病负担的一种很有前景的方法。为了为使用财政政策（包括税收和补贴）以促进健康提供指导方针，世界卫生组织委托对全球范围内此类政策对食品的结果进行了系统评价和荟萃分析。
评估实施的食品税和补贴对价格、销售、消费以及人群饮食和健康的影响。
从数据库建立到 2020 年 6 月 1 日，对 8 个书目数据库进行了同行评议文献搜索，并对 14 个数据源和政府网站进行了灰色文献搜索。没有语言和设置限制。
仅考虑实施的食品税和补贴的主要研究。
遵循系统评价和荟萃分析的首选报告项目（PRISMA）报告准则。使用三级随机效应模型对水果和蔬菜补贴的销售和消费结果进行荟萃分析。其他结果以叙述性综合形式进行分析。
荟萃分析中的研究估计值使用销售和消费结果的价格弹性度量值进行组合。使用 I2 统计量和 τ2 评估异质性。研究在衡量饮食和健康方面存在差异。
系统评价共纳入 54 篇文章，其中 15 篇文章纳入荟萃分析。大多数食品补贴针对水果和蔬菜以及低收入人群，而关于食品税的证据主要来自墨西哥的非必需高能量食品税。补贴水果和蔬菜的销售显著增加，需求价格弹性估计值为-0.59（95%CI，-1.04 至-0.13[P=0.02]；95%预测区间，-2.07 至 0.90；I2=92.4%[95%CI，89.0%-94.8%；P<0.001]），表明需求无弹性。补贴水果和蔬菜的消费没有显著变化，需求价格弹性估计值为-0.17（95%CI，-0.49 至 0.15[P=0.26]；95%预测区间，-1.01 至 0.67；I2=76.2%[95%CI，54.3%-87.6%；P<0.001]）。食品消费税与价格上涨和销售额下降有关。关于食品税和补贴对不同人群的结果差异的证据有限。
这项系统评价和荟萃分析的结果表明，水果和蔬菜补贴与水果和蔬菜销售的适度增长有关。需要进一步研究，以了解食品税和补贴对人群消费、饮食和健康结果的影响。
