Changing the prices of seven foods, including
fruits, vegetables and sugar-sweetened beverages, could reduce deaths due to
stroke, diabetes and cardiovascular disease and address health disparities in
the United States, finds a study led by researchers from Tufts University.
In the study, published today in BMC Medicine, the
team of researchers used a comparative risk assessment model to estimate the
potential effects of price subsidies on healthy foods, such as fruits,
vegetables, whole grains, and nuts and seeds, and taxes on processed and
unprocessed red meats and sugary drinks, on the number of annual deaths from
cardiometabolic diseases in the United States.
The researchers found that if the prices of all
seven dietary items were altered 10 percent each, an estimated 23,000 deaths
per year could be prevented; this corresponds to 3.4 percent of all
cardiometabolic disease deaths in the United States. A 30 percent price change
almost tripled that approximation with an estimation of 63,000 deaths prevented
per year, or 9.2 percent of all cardiometabolic disease deaths.
"This is the first time, to our knowledge, that
national data sets have been pooled and analyzed to investigate the influence
of food subsidies and taxes on disparities in cardiometabolic deaths in the
United States," said lead and corresponding author José L. Peñalvo, Ph.D.,
adjunct assistant professor at the Friedman School of Nutrition Science and
Policy at Tufts University. "We found that modest price changes on healthy
and unhealthy foods would help decrease overall cardiometabolic deaths and also
reduce disparities between socio-economic strata in the U.S. -- the largest
changes coming from reducing the prices of fruits and vegetables and increasing
the price of sugary drinks."
When the researchers looked at factors such as
educational attainment and socioeconomic status, they found that larger
proportions of deaths would be prevented among Americans with less than high
school or high school education, compared with college graduates. Additionally,
under low and high gradients of price responsiveness, subsidies and taxes would
reduce disparities in all cardiometabolic disease outcomes. Diabetes would be
significantly reduced by any of the scenarios.
"Our findings on disparities are particularly
relevant today, with growing inequities in diet and cardiometabolic disease.
The current strategies, such as education campaigns or food labeling, have
improved overall dietary habits, but much less so among people with lower
socioeconomic status," said senior author Dariush Mozaffarian, M.D.,
Dr.P.H., dean of the Friedman School. "These results suggest that
financial incentives to purchase healthy food, and disincentives to purchase
unhealthy foods, can prove successful in meaningfully reducing cardiometabolic disease
disparities."
The largest proportional reduction in
cardiometabolic disease outcome was observed for stroke, followed by diabetes.
Diabetes deaths were most influenced by taxes on sugar-sweetened beverages,
while stroke deaths were most influenced by subsidies for fruits and
vegetables. The researchers acknowledge that the efficacy of taxation will
depend on what products consumers chose as an alternative. Therefore, this is
the most likely average effect of price changes.
The researchers defined the seven dietary elements
based on evidence of their associations with cardiometabolic diseases,
including stroke, diabetes and overall cardiovascular disease, and policy
interest. From there, the researchers investigated the price responsiveness of
each food item to price change and how each price intervention could prevent
deaths and disparities from cardiometabolic diseases using different price
responsiveness scenarios.
The team used nationally-representative data from
2012 on the consumption of selected food items by age, gender and socioeconomic
status; estimates of etiological effects of these foods on cardiometabolic
disease by age; observed national cardiometabolic disease deaths by age, gender
and socioeconomic status; and estimated the impact of pricing changes on
dietary habits by socioeconomic status.