Title: Health Economic Analysis incorporating effects on Labour outcomes, Households, Environment and Inequalities (HEALTHEI) for food taxes
Funder: Department of Health and Social Care

Abstract: Eating unhealthy foods leads to excess weight and health-related issues. We know that there are links between living in a disadvantaged community and poor diet and poor health. The most disadvantaged people are likely to have more health issues and may die younger. Some experts think that putting taxes and subsidies on food will encourage healthy eating. This in turn could reduce obesity-related health issues and create fewer differences in health between more and less advantaged communities._x000D_ _x000D_ It is thought that if you put up the price of unhealthy foods, people will eat less of these and choose healthier foods instead. This might be a particularly helpful strategy with disadvantaged communities. The success of a policy like this depends on factors such as how businesses respond, whether changes actually improve diet, and whether any changes happen which aren’t expected. These are all important to think about when working out what the effects of new food taxes might be._x000D_ _x000D_ The purpose of the study is to talk to all stakeholders about what the next food taxes should be, and what they should be on. We will look at the way taxes might affect the whole food system, trying to answer the following questions:_x000D_ · Can tax changes affect what people eat, and if so how?_x000D_ · Might tax changes improve health and reduce NHS costs?_x000D_ · What might the effects be on disadvantaged communities?_x000D_ · What might the effects be on employment and the economy?_x000D_ · How might these changes impact on the environment?_x000D_ _x000D_ The work carried out during the study will be:_x000D_ Work Package 1_x000D_ 1. Holding workshops and interviewing stakeholders (members of the public, policymakers and experts) to ask them what sort of tax should be introduced on what foods._x000D_ 2. Looking at what is already known in research studies, to help stakeholders with their thinking and suggestions._x000D_ 3. Looking at social media, magazines and newspapers to see how food taxation is portrayed._x000D_ Work Package 2_x000D_ 4. Looking at how the public might change what they buy as a result of food taxation._x000D_ Work Package 3_x000D_ 5. Looking at how industry might change prices and ingredients in response to food taxation._x000D_ Work Package 4_x000D_ 6. Looking at the how peoples’ health, the environment, and inequalities in society might be affected by tax changes._x000D_ 7. Carrying out workshops with stakeholders to develop recommendations for future policy._x000D_ _x000D_ We have discussed the proposal with members of the public who agreed that the topic was important. They helped us decide to focus on sweet and salty snacks and takeaways and encouraged us to look carefully at possible effects on health and spending amongst disadvantaged groups. During the study we will set up a diverse group of 8 to 10 people who will be our public advisory group. They will be recruited via relevant voluntary and community groups including the Sheffield DeepEnd group, which includes residents in more disadvantaged areas of the city and using the People in Research website. This group will help us design the content of the workshops and suggest how to go about recruiting people to attend. Later in the study they will help us understand what the findings mean, and assist in planning how we will let people know about them._x000D_ We will use webinars, workshops, scientific presentations and write papers for academic journal articles to let people know about our findings. We have a good record of getting news coverage for our work so that the public and policy makers hear about it.

Lay abstract: The excess consumption of calories in the UK leads to obesity, which is a cause of diabetes and cardiovascular disease. Unhealthy diets, in which consumers eat excess quantities of food High in Fat, Sugar and Salt (HFSS), are causing ill health and are an influential factor in creating health inequalities. _x000D_ _x000D_ Increasing the price of HFSS products could reduce the consumption of unhealthy foods, with potential health benefits. There is increased political interest in weight loss due to the Covid-19 crisis. There are many options available to target different food products, or nutrients profiles, at point of sale, or targeting manufacturers. The specification of these policies could impact the overall benefits to health and/or consequences to other sectors (employment, economy, environment) and health inequalities. There is a need for evidence on the potential health, economic and environmental benefits of food taxes in the UK. However, food taxes may be unpopular, and the negative consequences of food taxes must also be considered. The potential for unintended consequences and adverse effects in the wider system, such as impacts on low income households, is also needed to identify policies with potential for implementation._x000D_ _x000D_ HEALTHEI (Health Economic Analysis incorporating effects on Labour outcomes, Households, Environment and Inequalities) will identify the most promising strategies for food taxes and generate evidence on their potential impact on health and wider societal outcomes. _x000D_ _x000D_ We will establish:_x000D_ 1. Which food taxes are most likely to be feasible and acceptable to implement in the UK?_x000D_ 2. What are the likely consumer responses to price changes on products consumed in and out of home? How do these responses vary between social groups?_x000D_ 3. What are the likely industry responses to pass-through price increases to consumers? Will the policies lead to reformulation?_x000D_ 4. What are the likely impacts of food taxes on wider societal outcomes including, household spending by social groups, local/global supply chains, environmental outcomes and macroeconomic indicators?_x000D_ 5. What are the likely impacts of food taxes on health outcomes, health related quality of life, National Health Service (NHS) costs, health related labour outcomes?_x000D_ 6. How are health outcomes distributed and do they reduce health inequalities?_x000D_ _x000D_ HEALTHEI will inform policy makers on the viability of food taxes, and provide a detailed systems evaluation of the potential impacts of three policy options. We will work with the public, food advocacy groups and policy makers to tailor food taxes, assess the relative benefits of these, and improve dissemination to public and policy makers. _x000D_ _x000D_ We will use UK datasets to understand how consumers and industry will most likely respond to policies. Consumer and industry responses may vary between social groups and foods and this will impact the effectiveness and distribution of benefits. Opportunities for reformulation will be explored as this will likely vary between food groups. _x000D_ _x000D_ We will use multiple modelling frameworks to extrapolate simulated changes in purchases to wider societal outcomes. For the health and health related impacts the SPHR diabetes prevention microsimulation model will allow dynamic simulation of individuals' nutritional intake and outcomes to be stratified by social groups. We will explore uncertainty in our estimates with probabilistic and scenario sensitivity analysis.

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE