Altering the prices of seven major food groups could save more than 23,000 lives a year in the United States by slashing cardiometabolic risks, a study published in BMC Medicine this week reports.
These are deaths that otherwise would be attributable to coronary heart disease (CHD), diabetes and stroke, lead author and Tufts professor José L. Penalvo, PhD, and colleagues wrote in the study. And, though a handful of global entities have already assumed the task of adjusting prices to promote healthier lifestyles, Penalvo et al. wrote no such acclaimed research previously existed in the U.S.
“A suboptimal diet is a major cause of cardiometabolic disease (CMD),” the authors wrote. “Among strategies to improve dietary behaviors, fiscal interventions to alter food prices are promising. Such approaches may not only improve population health, but also potentially reduce disparities in diet quality and diet-related health burdens.”
Maintaining a balanced diet is becoming more difficult, Penalvo and co-authors wrote, with a widespread obesity epidemic and limited access to affordable, healthy food choices. Cardiovascular disease—the country’s leading cause of death—statistically affects more individuals who rank low on the socioeconomic scale and fewer wealthy Americans.
In an effort to “address knowledge gaps and inform policy-makers,” the researchers pulled data from the 2012 National Health and Nutrition Examination Survey (NHANES) on the country’s consumption of certain food items and studied those numbers against age, sex and socioeconomic status (SES). Education levels were used as strong indicators of SES, the authors wrote, since U.S. mortality datasets don’t routinely collect income data.
Penalvo and his team studied seven food categories—fruits, vegetables, whole grains, nuts and seeds, processed meat, unprocessed red meats and sugar-sweetened beverages (SSB)—the latter three of which were proposed for higher taxation. The first four food groups were subject to price subsidies.
The authors found that a 10 percent decrease in fruit prices would result in a 15.5 percent increased consumption rate among individuals who didn’t complete high school, a 14.2 percent increase among those who completed high school or some college, and a 13.1 percent increase among college graduates. On the other hand, a 10 percent increase in prices of SSBs would decrease estimated consumption by 7.3 percent, 6.7 percent and 5.6 percent, respectively.
These trends continued throughout the data, though among individual dietary factors, the greatest estimated impact came from reducing the prices of vegetables, fruits and nuts. Those alterations would result in a combined 14,972 fewer CMD-attributable deaths per year, Penalvo and colleagues wrote.
By jointly shifting the prices of all seven food groups by 10 percent each, and assuming a low SES gradient, the authors found 23,174 deaths per year could be prevented in the U.S—3.4 percent of all CMD deaths in the nation. By altering each price by 30 percent, that number climbs to an estimated 63,268 prevented deaths a year, which corresponds to 9.2 percent of all CMD mortalities.
“Our findings suggest that the benefits of taxes for both health and disparities would be strongly complemented by accompanying strategies to reduce the price of fruits, vegetables, nuts and whole grains,” the authors wrote. “Subsidies are an essential component of a balanced pricing strategy to effectively improve diets, as well as to minimize the regressive nature of taxation alone.”
These fiscal strategies have been successful in other countries, they noted, including the earliest example: a 2011 Danish tax on saturated fat. Though the tax was rescinded in 2013, estimates projected national saturated fat intake was cut by 4 percent. Sugar taxes exist in Hungary, Latvia and Finland, SSB taxes are making their way across the U.S. and Portuguese residents find higher price tags on high-salt products. South Africa and the U.K. are also debuting SSB taxes in 2017 and 2018, respectively.
“Strategies introducing modest price changes on key dietary factors could reduce cardiovascular disease and diabetes burdens and disparities in the U.S.,” Penalvo et al. wrote. “The findings of our study have broad implications for policy-makers targeting fiscal measures to reduce CMD burden.”