The economic burden of excessive sugar intake and the impact of sugar taxes in Canada

• Author / Creator

  Liu, Siyuan

• Consumption of sugars is associated with obesity and various chronic diseases (CD). Excessive sugar consumption leads to economic burdens in terms of health care costs for treatment and management of CDs and costs associated with lost productivity and premature mortality. With increasing concerns about the health and economic consequences of excess sugar consumption, the sugar tax is increasingly considered a population-level policy to curb sugar consumption. Currently, Canada has not yet implemented sugar taxes and other alternative population-level interventions. There is little information about the economic burden of excessive sugar consumption and the impact of the sugar tax in Canada. Thus, this thesis aims to: 1) estimate the consumption and dietary sources of added, free and total sugars in Canada, 2) quantify the economic burden that could be avoided if Canadians comply with existing free sugar consumption recommendations, 3) systematically review and analyze evidence regarding the cost-effectiveness of taxation of sugary foods and beverages, 4) build a model to estimate the potential health and economic impact of sugar-sweetened beverage (SSB) tax in Canada, and 5) estimate the cost-effectiveness of different taxation and subsidy scenarios in Canada.
  This thesis consists of five interconnected studies. The first study calculated added, free, and total sugar content of all foods consumed by Canadians using the established nutrient calculation procedures and the 2015 Canadian Community Health Survey–Nutrition dataset. This study reveals that most Canadians consumed more added and free sugars than recommended (less than 5% or 10% of total energy intake). The second study quantified the economic burdens of excessive free sugar intake using the population attributable fraction method. The findings show that if Canadians were to comply with the free sugar recommendation, an estimated CAD$2.5-5.0 billion in direct health care and indirect costs could have been avoided in 2019. The third study systematically reviewed fifteen sugar tax economic evaluations from six countries. All these studies revealed that the sugar tax is a cost-effective intervention to improve health-related quality of life, save health care costs, and gain tax revenue. In the fourth study, we designed a proportional multi-state life table-based Markov model to simulate the SSB tax in Canada. Compared with the previous studies, the simulation model included more CDs and considered substitute effects of all untaxed products. The fifth study estimated the cost-effectiveness of different sugar taxes and vegetables and fruit (V&F) subsidy scenarios in Canada using the established model built in the fourth study. The results show that all simulated taxes and subsidies were cost-effective, and the combination of taxes and subsidies could maximize health benefits and compensate for the sugar tax burden.
  Overall, this thesis fills the research gaps about the sugar content of foods and beverages as well as excessive sugar consumption and its consequent health and economic burden in Canada. It calls the public, researchers, and policymakers’ attention to excessive free sugar consumption and potential interventions. This thesis provides profound evidence regarding the impact and cost-effectiveness of different taxes and subsidy scenarios for researchers and policymakers. The findings support the implementation of a policy package that includes sugar taxes and V&F subsidies to maximize health benefits and improve inequity.

• Subjects / Keywords

  • health policy
  • economic evaluation
  • sugar
  • taxation

• Graduation date

  Spring 2022

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-1her-4356

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.