School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK.
BMC Public Health. 2022 Aug 16;22(1):1557. doi: 10.1186/s12889-022-13945-9.
Taxes on discretionary foods and sugar-sweetened beverages have emerged as a strategy for health promotion. Between 2018-2019, the Bermuda government introduced a phased tax on imported sugar-sweetened beverages, confectionery, products containing cocoa and pure sugar, and eliminated import duties on select healthy food items. The aim of this study was to conduct an mixed methods evaluation of perceptions of the tax among the general population and key stakeholders.
We conducted a survey of the general population (N = 400), and semi-structured interviews with key informants (N = 14) from the government, food and beverage, and health sectors to understand awareness, acceptability, and perceived impact of the tax after implementation. Survey data was analysed using thematic analysis, summary statistics, and Chi-squared tests. Key informant interviews were analysed using the framework method.
General population respondents had high awareness of the sugar tax (94%) but low awareness of the healthy food subsidy (32%). Most respondents (67%) felt the tax was not an appropriate way to motivate healthier consumption due to beliefs the tax would not be effective (44%), and because of the high price of healthy food (20%). However, nearly half (48%) reported consuming fewer taxed products, primarily for health reasons but also motivated by price increases. Key informants indicated there was high awareness but limited understanding of the tax policy. Informants expressed support for taxation as a health promotion strategy, conditional on policy implementation. The lack of clear price differentiation between taxed and un-taxed products and the absence of accompanying health education were key factors believed to affect the impact of the tax. No informants were aware of use of tax revenues for health purposes and tax revenue was reportedly re-directed to other priorities after implementation.
There was high awareness, but limited acceptability of the Bermuda sugar tax as implemented. Clarity in the tax policy, appropriateness of the tax mechanism, and use of revenue in alignment with the tax aim are critical components for acceptance. The absence of complementary education and health promotion affected acceptance and may limit potential health impacts. The lessons learned in Bermuda can inform similar policies in other settings.
对可自由支配食品和含糖饮料征税已成为促进健康的一项策略。在 2018 年至 2019 年期间，百慕大政府对进口含糖饮料、糖果、含可可和纯糖的产品征收阶段性税，并取消了部分健康食品的进口关税。本研究旨在对公众和利益攸关方对该税的看法进行混合方法评估。
我们对公众（N=400）进行了调查，并对政府、食品和饮料以及卫生部门的 14 名关键信息提供者进行了半结构化访谈，以了解实施后的税收意识、可接受性和预期影响。使用主题分析、汇总统计和卡方检验对调查数据进行分析。使用框架方法对关键信息提供者访谈进行分析。
公众受访者对糖税（94%）的认识度很高，但对健康食品补贴（32%）的认识度很低。大多数受访者（67%）认为税收不是激励更健康消费的适当方式，原因是他们认为税收不会有效（44%），而且健康食品价格太高（20%）。然而，近一半（48%）的受访者报告说，他们消费的应税产品减少了，主要是出于健康原因，但也受到价格上涨的影响。关键信息提供者表示，他们对税收政策的认识度很高，但理解有限。信息提供者表示支持将税收作为促进健康的一种策略，但前提是政策得到实施。税收政策缺乏对征税和未征税产品之间的明确价格差异，以及缺乏伴随的健康教育，是被认为影响税收影响的关键因素。没有信息提供者意识到税收收入用于健康目的，据报道，税收收入在实施后被重新用于其他优先事项。
百慕大的含糖饮料税虽然有很高的认知度，但可接受性有限。税收政策的明确性、税收机制的适当性以及税收收入与税收目的的一致性是被接受的关键组成部分。缺乏补充教育和健康促进措施会影响接受程度，并可能限制潜在的健康影响。百慕大吸取的经验教训可为其他地区的类似政策提供参考。
