Award Title: COPPER: CO-designing  for healthy People and Planet: food Economic policy Research
Funder: Department of Health and Social Care

Abstract: The foods that we eat have an impact on our health and the health of the planet. Eating lots of foods rich in sugar, fat and salt and low in whole grains, fruits and vegetables makes us more likely to suffer from diseases like obesity, diabetes, heart disease and certain cancers. People from disadvantaged backgrounds are more likely to suffer from these diseases. Food is also responsible for a third of all greenhouse gas emissions in the UK. If we are to keep ourselves and our planet healthy, we need to change what we eat. Adding subsidies (making foods cheaper) and taxes (making foods more expensive) to our food could help us eat more healthily, and eat foods that are better for the planet. They might also reduce the differences in health that we see between the rich and the poor._x000D_
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The aim of our project is to work with the public and policy makers to estimate what impact different taxes and subsidies might have on the foods we eat. We will then work out whether or not that will make us healthier and reduce pollution. We will also work out the impact on how much money households have to spend and on the UK economy as a whole._x000D_
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To do this, we will come up with a list of options, such as reforming VAT, taxing sugar and salt in foods, and subsidising fruits and vegetables. We will then run a survey to ask the public what they think of these different options, and compare what the public think to how easy these would be to turn into policies. We will then hold two-day meetings with members of the public, including those from disadvantaged backgrounds, and give them evidence about the foods we eat, the impact they have on our health, environment and economy. Participants will be asked to choose which of the policies from our list of options they think are best. We will then take these options to a meeting with government policy makers, to see which options they would choose._x000D_
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We will look at data on people’s shopping patterns to work out what happens to how much food people buy when prices go up and down. We will then build models to work out what changes the taxes and subsidies will have. These ‘models’ are computer simulations – we will use the best evidence available to predict what will happen in different scenarios. First, we will predict how different taxes and subsidies will change what people are buying and eating, and how much it will cost households. We will then model how these changes affect the environment. _x000D_
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Raising or lowering food prices will also affect businesses, like food manufacturers and retailers (e.g. supermarkets). We will model how businesses might respond to these policy options. For example, if a tax on sugar were to be introduced, we need to know how a business would change the price of a product. Alternatively they might make different changes, like swapping ingredients in the foods they produce, to avoid paying a tax. We will also predict what impact taxes and subsidies will have on jobs and the UK economy as a whole_x000D_
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To estimate what impact all these changes on food prices might have on the NHS, we will use a health model. This will predict the change in body weight, heart disease, diabetes and cancer as a result of changes in the foods that we eat. Throughout the project, we will keep the public involved to make sure that our findings are shared in a clear way.

Lay Abstract: Background: The food that we eat in the UK impacts on our health and our wallets, with particularly large impacts for the poorer in our society. It also impacts on planetary health and the UK economy. One option to address these challenges is to introduce food taxes and subsidies to incentivise healthy, sustainable food and support low income groups. But taxes and subsidies are politicially difficult to introduce due to concerns over individual agency and stigmatisation. For such policies to be successful, it is vital that they are co-designed with the public and policymakers and their potential impact across multiple outcomes is established. _x000D_
Research questions: What impacts could food taxes and subsidies have on a) the incidence and prevalence of, inequalities in, and consequences for chronic non-communicable diseases? and b) household-level economics, national-level macroeconomics, greenhouse gas emissions, land use, water use and water pollution._x000D_
Aims and objectives: We will co-design tax and subsidy scenarios with public and policymakers, develop a research infrastructure of linked datasets and integrated health, economic and environmental models, estimate the impact of six scenarios and communicate our results with public and policymakers._x000D_
Methods: We will conduct a scoping review of the literature to identify a longlist of scenarios that improve health, reduce health inequalities and/or reduce environmental impact. We will assess public attitudes to the longlist via a survey and discrete choice experiment (DCE) with a representative sample and a low-income household boost. We will hold three deliberative forums with disadvantaged groups where we will present evidence from the survey and DCE alongside information about the health and environmental impact of the food system, the ethics of food taxes and subsidies, and their potential impact on the food industry. Forum participants will rank the longlist of scenarios and we will combine their findings to produce a shortlist of six, which will be refined and ratified at a meeting with public and policymaker representation. We will use household food purchasing data linked with environmental outcome measures to fit a consumer demand model. We will estimate the impact of the scenarios on nutritional quality, price of the diet and environmental outcomes for different income groups. The long-term impact on incidence and prevalence of obesity, diabetes and diet-related diseases, and NHS costs will be modelled using a validated proportional multistate life table model. Our results for health, healthcare costs, and changes in food sales will be used to estimate how the scenarios change GDP, jobs in the food industry and tax revenue using a computable general equilibrium macroeconomic model. _x000D_
Timelines of delivery: Deliberative forums will be held at the end of the first year; data linkage and model infrastucrure and early scenario results will be completed by the end of the second year; full results and dissemination will be completed in year 3._x000D_
Anticipated impact and dissemination: We will work with public and policymaker representatives throughout to ensure our communication strategy is tailored to their needs. We will disseminate our findings through Food Foundation workshops, traditional media and social media. We will circulate policy briefs, and produce result summaries for lay audiences.

Research Activity Codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health Categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE