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1 An “Alarm Signal” to the Population

1 An “Alarm Signal” to the Population

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Potential “Signal” Effects from Sugar-Sweetened Beverage Taxation

May the tax be negatively perceived

by some consumers and accentuate

their preference for SSBs ?

Does the tax influence

opinions and intentions?

Has the tax


been supported by

a communication

campaign ?



Depreciation of

SSB consumption

social norms










(in the long term)


reformulation by


and development

of healthier


Is the tax rate high

enough to raise


awareness ?

Would a tax discourage

or encourage industries’

voluntary efforts?

Will consumers adhere to

reformulated products or

new healthier options ?

Fig. 11.1 Uncertainties about the propensity of SSB taxation to generate a salient public health

signal positively affecting SSB consumption’s social norms and fostering product reformulation

availability) and at the market level (e.g. low SSB price, living near a fast-food or a

convenience store) (Hector et al. 2009; Mazarello Paes et al. 2015; Tak et al. 2011;

Verloigne et al. 2012). For example, in Australia, a study based on a large-scale

cross-sectional survey conducted in 2010 showed that children aged 4–10 years

were almost three times as likely to be high SSB consumers (  5 cups/week) if

they purchased SSBs from their school canteen. For youth aged 9–16, the ratio rose

to 5 times if SSBs were “usually available at their home” and to 10 times if SSBs

were “usually consumed with meals at home” (Hebden et al. 2013). In sum, many

characteristics of the market, school and family environments may contribute to

making or maintaining SSB consumption a social norm1 in some groups of the

population. This social norm seems to be particularly salient among adolescents.

For example, in the USA and the UK, two studies highlighted by Baril et al. (2014)

have shown that adolescents tend to overestimate SSB consumption of their peers

and to overestimate how positive their peers feel about it (Perkins et al. 2010; Lally

et al. 2011). This social norm may contribute to stimulating SSB overconsumption.

In such circumstances, among other instruments, SSB taxation could be used as

“alarm signal” counteracting SSB consumption social norms, i.e. making it less

Baril et al. (2012, p. 6) define social norms as “socially shared rules and behavioural models,

based on common values and implying a pressure in favour of the adoption of a given behaviour,

at the risk of disapproval from the society or the reference group” (free translation).



An “Alarm Signal” to the Population


acceptable and desirable in the population (Fédération québécoise du sport étudiant

[FQSE] 2010). In other words, taxes might alleviate the current “high consumption”

norm and reinforce instead the emergence of a “moderate consumption” norm, as

advocated by public health proponents and experts. Some prerequisites may be

necessary to produce such a signal: (1) the price hike would have to be sufficiently

salient; (2) the population would have to be sufficiently aware of the tax; and (3) the

two precedent conditions may have to be sustained by a large communication

campaign focused on the tax. For example, in Hungary, a study conducted by the

National Institute for Health Development (NIHD) (quoted by Ecorys 2014, p. 219)

indicates that among the consumers having reduced their consumption of

pre-packaged sweets and salty snacks following the introduction of taxes in 2011,

80 % reported having done so primarily because of price changes, but 20 %

reported having done so because “they became aware of the fact that the consumption of such products is unhealthy”. The NIHD concluded that the tax may

have been more effective if greater public communication efforts had been committed. This area deserves further attention. For example, it would be worth analysing if (and how far) the controversies and strong advocacy campaigns that have

surrounded the soda tax bills in Mexico (in 2013) and Berkeley (in 2014) have

fostered lower SSB purchases (beyond the influence of price hikes once the tax was


However, using soda taxes as a signal may also have counterproductive effects:

research has shown that banning the consumption of some foods (including SSBs)

tends to accentuate children’s preference for it (Baril et al. 2014). Consequently, the

preference for SSBs in children may get reinforced if the tax is explicitly presented

as a way to restrict consumption (Farley et al. 2012). Actually, data from the

Enquête Québécoise sur la Malbouffe conducted in 2010–2011 in 9941 Quebec

secondary school children2 show that, among the students willing to change their

“junk food habits” and having carbonated beverages at least once or twice a week,

nearly 4 out of 10 students (38 %) indicate their intention to reduce their SSB

intake. For those students, may SSB taxation work as a facilitator? This is uncertain

as, overall, in this survey, soft drink taxation is the most unpopular option to reduce

“junk food” consumption (28 % of agreement) in comparison with others such as

improvements in nutrition labelling (62 %) or improvements in the food offered in

the places students often visit (corner shops, movie theatres, etc.) (60 %)

(Hovington and RESQ 2012). This is part of the reasons why Just and Wansink

consider that “voluntary approaches (e.g. making soft drinks less visible and less

convenient) are much more likely than regulations to create long-term behavioural

habits and much less likely to create a class of soft-drink freedom fighters” (Farley

et al. 2012, p. 1466).


This study aimed to collect a minimum number of questionnaires by school (30) and by region

(100) in order to strengthen the statistical validity of the results. In fact, 36 out of the 87 schools

and 2 out of the 14 regions surveyed did not reach these minimum numbers. Design weights were

not consequently adjusted (Hovington and RESQ 2012). Therefore, even if the survey is based on

a very large sample of students, it should be noted that it is not a probability-based survey.



Potential “Signal” Effects from Sugar-Sweetened Beverage Taxation

From another angle, the “tax signal” may have greater impact on adults’ SSB

consumption norms, which may indirectly impact consumption in youth. Indeed,

research indicates that children whose parents regularly consume SSBs are more

likely to consume SSBs themselves (Baril et al. 2014). Furthermore, data indicate

that SSB taxation may be more acceptable for adults than for youth. Further

research should be conducted to better estimate SSB taxation awareness and

acceptance in the population as well as related effects on intentions and behaviours

(see also Chap. 13).

For example, a cross-sectional study analysed Belgian citizens’ (n = 565)

awareness and acceptance of fiscal measures implemented in neighbouring countries (i.e. “fat tax” in Denmark, “soda tax” in France and “public health nutrition

tax” in Hungary) (Mustafa 2013). Among cola consumers (n = 405), 30 % reported

that a tax similar to the French soda tax would make them reduce their cola

consumption, whereas 60 % reported that they would likely not change their habit

and 10 % would actually increase their consumption.3 However, overall, the results

indicate that the awareness of these food taxes was relatively low4 in the sample of

Belgian citizens under study and was significantly correlated neither with their level

of acceptance of these taxes nor with the purchase intention of taxed products

(Mustafa 2013). It suggests that the “signal” conveyed by food taxes in a population

operates in a complex environment and may contribute to diverging opinions,

intentions and behaviours within and across consumers. For example, in this study,

high-income individuals showed greater awareness (not acceptance) of fiscal

measures, but their purchase intention of taxed products did not significantly differ

from other consumers. Similarly, those with higher nutrition knowledge showed

greater level of acceptance (but not awareness) of fiscal measures, but their purchase

intention of taxed products did not significantly differ from other consumers. The

author suggests to explore these variables during the evaluation of food taxes

actually implemented at a large scale (Mustafa 2013). The use of multivariate

models and larger samples would likely be helpful to disentangle the respective

contributions of these different factors (see Sect. 11.4).


A “Coercive Signal” to Manufacturers

On the other hand, taxing SSBs could send a coercive signal to engage manufacturers into moving beyond voluntary commitments (Boizot-Szantai and Étilé 2011),

be this in terms of product reformulation and/or in terms of marketing to children.

The propensity to reduce consumption was higher for “special foods” (e.g. energy drinks) than for

common foods (e.g. butter) (Mustafa 2013).


For example, 7.4 % reported being very “well aware” of the French soda tax (implemented since

January 2012), whereas 32.2 % reported “having heard” about it without being “sure”, and 60.4 %

said they had “never heard” about it (Mustafa 2013).



A “Coercive Signal” to Manufacturers


Firstly, SSB taxation could be used as a signal to catalyse product reformulation

across all SSB brands and categories. The recent downward trend in SSB demand in

many countries seems to have already favoured this innovation process, e.g.

through the replacement of added sugars by low-calorie intense sweeteners (e.g.

stevia) (Euromonitor 2014). In parallel, some of the biggest SSB companies have

already launched large-scale corporate programmes to demonstrate their willingness

and efforts in developing and promoting a healthier portfolio of beverages (Arthur

2015). A new tax or increases in the rate of existing taxes may further pressure

manufacturers into reducing the sugar content of their products and could contribute

to accelerate the development and promotion of healthier alternatives. In Hungary,

for example, a case study conducted by Ecorys indicates that the “Public Health

Product Tax” (PHPT) explicitly raised attention of the industry on public health

issues and may have favoured a number of pro-health initiatives in terms of

reformulation, health impact assessment and public–private negotiations (Ecorys

2014, p. 222). At the opposite, according to Ecorys, industry stakeholders from

several countries have claimed that many improvements had already started prior to

the introduction of health-related food taxes and that these new taxes may actually

have slowed this progress for two reasons: (1) taxes may be perceived as a signal

discouraging voluntary efforts, e.g. those aimed to reduce (but not eliminate) SSBs’

sugar content5, and (2) in some cases, additional taxes may reduce the capacity of

investment in product innovation (Ecorys 2014, p. 208, 242).

From this perspective, a tax linearly indexed on the sugar content of the beverages (i.e. an “input tax”) may prove much more virtuous than a tax hitting

indifferently all types of calorically sweetened beverages. In the case of alcohol, a

specific tax amount based on the quantity of alcohol (rather than the volume of

liquid) has proved to encourage the production of lower alcohol beverages and to

foster healthier consumption patterns (e.g. case study on beers in South Africa)

(Blecher 2015). However, administratively speaking, such a tax is more likely to

raise feasibility concerns (see Sect. 12.4). Among the cases of SSB taxation listed

in Table 1.1, Mauritius (excise tax of 3 cents per gram of sugar content in the

targeted beverage) is the only case (WCRF 2015). An alternative likely easier to

administer would consist in fixing a threshold of sugar content above which beverages are taxed. For example, such an approach has been used for SSB taxation in

Denmark (  0.5 g of sugar/100 mL), in Finland (>0.5 g of sugar/100 g or mL),

in Hungary (>8 g of added sugars/100 mL), in St Helena (  15 g of sugar/L) and

in Chile (>6.25 g of sugar/100 mL) (see Table 1.1, column 4). Such proposals are

attractive in that they may encourage manufacturers to reformulate existing products (provided technological and taste requirements are met) or to develop

lower-calorie options. Such effects remain to be demonstrated.

Secondly, SSB taxation could also be used as a signal contributing to counteract

and “denormalize” SSB marketing to youth (FQSE 2010). Indeed, the marketing of


Reducing SSBs' sugar content is recognized to be a technological and marketing challenge, since

taste is a critical choice parameter for SSB consumers.

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