Introduction

Consumption of highly caloric beverages laden with sugars has been linked to obesity and overweight problems worldwide.1, 2, 3 Consumption of sugar-sweetened beverages (SSBs) serves as the leading source of added sugars and a major energy contributor in the US diet4, 5 and is markedly higher for adolescents as compared with children, and for young adults, as compared with older adults.6, 7 Production and consumption of SSBs continues to increase worldwide. Consumption of soft drinks in Latin America and Eastern Europe alone is expected to grow by 15 per cent between 2009 and 2014.8

In response to growing concerns about SSB consumption and obesity, governments are pursuing policy options to reduce SSB access and/or increase SSB prices. The access-focused policies have centered on school-based restrictions, with recent evidence indicating that they are associated with reduced in-school access and/or consumption.9, 10 Governments have also begun adopting policies aimed at reducing SSB access in public venues, such as by requiring healthy vending and procurement policies for beverages sold/served in government-owned/operated locations.

On the price side, drawing from the success of tobacco taxation in reducing smoking prevalence among adults and youth, the public health community has called for SSB excise taxes of at least 1 cent / liquid ounce as a way to increase SSB prices significantly, reduce consumption, and reduce obesity rates.11, 12 In the United States, several state and local governments have considered imposing excise or significantly higher sales taxes on SSBs; however, to date, none of these recent efforts has succeeded.13 Internationally, several European and Pacific countries have reinstated, introduced, or are considering similar taxes.14, 15, 16, 17, 18

Most of the current tax schemes – which, in the United States, at least, are based on small sales taxes20 ranging from 1 to 7 per cent as of 1 January 2013 (see Table 1) – generally are too low to have meaningful impacts on overall consumption and weight/obesity.21, 22, 23, 24, 25 A recent review by Powell and colleagues shows that SSB consumption has a price elasticity of −1.2, suggesting that a tax that raises prices by 20 per cent will reduce consumption by 24 per cent.26 Recognizing this, recent proposals have called for sizeable taxes as a way to reduce caloric intake and consumption.11 Smith and colleagues estimated that a tax-induced 20 per cent price increase on caloric sweetened beverages would, on average, reduce adult and children’s daily caloric intake by 37 and 43 calories, respectively (3.8 and 4.5 pounds, respectively, annually).27 Andreyeva and colleagues estimated that a 1 cent / ounce SSB tax in the United States could reduce daily caloric intake from 190–200 calories/day currently to 145–150 calories/day, assuming no substitution to other beverages.28

Table 1 State sales taxes on selected beverages as of 1 January 2013 (Source: Bridging the Gap Program 2013)

The emerging evidence base and recommendations plus the need for additional revenues means governments worldwide are considering taxing SSBs. Such proposals are often met with extensive opposition – particularly from the beverage industry and from retailers concerned about job losses and/or lost revenue. Denmark recently repealed a ‘fat tax’ and a ‘sugar tax’ after the first year. The ‘fat tax’ had taxed foods high in saturated fat. It was criticized for raising food prices for consumers, making Danish products more expensive than imported foods, increasing administrative costs for food companies, and leading to job losses.29, 30 In a US example, the beverage industry spent US$4.1 million during the November 2012 election cycle to defeat ballot measures in Richmond and El Monte, California. Both measures would have added a penny-per-ounce tax to regular soda with monies to be dedicated to childhood obesity prevention activities. In comparison, supporters of the measures spent only $114 000.31

In addition to the political and societal challenges that policymakers face when considering such taxes, they must decide between several policy approaches to beverage taxation. Recent papers by Thow19 and Mytton18 offer useful overviews of the issues and global context for taxing to achieve public health nutrition, and taxing of unhealthy foods and drinks, respectively. We believe that this is the first study to examine beverage taxation globally and to identify factors that decision makers should consider when seeking to tax beverages.

Key Factors to Consider about Beverage Taxes

There are three key factors to consider when contemplating beverage taxes: (i) what type of tax to apply plus how and where the tax is to be collected and presented to consumers; (ii) what types of beverages to tax; and (iii) the amount of tax that will be needed to affect consumption and/or obesity prevention-related revenue generation. While the taxation approach will vary by country, the following discussion reviews the key considerations. Table 2 summarizes key terms used throughout the remainder of this article and Table 3 summarizes the options we present.

Table 2 Definitions of key terms
Table 3 Beverage taxation considerations

(i) What type of tax to apply, how to apply the tax, where to collect the tax, and where the consumer ultimately sees the tax ‘incorporated’? (Columns 1–4 of Table 3 summarize the options)

The tax may be in the form of an excise, sales, or a value-added tax (VAT) (see Table 2 for definitions). An excise tax would be levied before the point of purchase, so it would be presented to the consumer through an increase in the shelf price (that is, the point at which purchase decisions are being made). It may be a specific tax (for example, 1 cent / ounce, 1 cent / teaspoon of added caloric sweetener, $0.20/liter) or ad valorem (for example, 10 per cent of price). Excise taxes are easier to collect as they are typically collected earlier in the distribution process, when there are fewer entities from which to collect taxes. This lowers the administrative costs and the likelihood of tax evasion.

Sales taxes are ad valorem taxes applied at the point of purchase (that is, at the cash register), presented to the consumer only on the final cash register receipt, and collected at the point of sale. VATs are broad-based consumption taxes assessed on the value added to goods, such as SSBs, at each stage in the production/distribution/retail chain. Governments collect them fractionally, based on a system of partial payments at each stage in the chain.32 In most cases, goods and services taxes (GST) and harmonized sales taxes (HST) are forms of VAT taxes (see Table 2).

Specific taxes offer several advantages over ad valorem taxes including, but not limited to, the following: (i) their impact does not fluctuate with the price; thus they reduce relative price gaps when imposed or increased, making it less likely that consumers will substitute down to cheaper beverage options in response to taxes and tax increases (for example, going to cheaper beverages or high volume options that are cheaper per ounce);33 (ii) they produce more predictable/stable revenues, important if these are to be used to fund obesity prevention efforts. If the tax is high enough, it will induce larger declines in consumption;27, 34 (iii) they are not subject to the same sort of industry price manipulation as ad valorem taxes; and (iv) they are easier to administer because the taxes are based solely on volume. Specific taxes, however, have the disadvantage of needing to be regularly adjusted to keep pace with inflation.34

In contrast, ad valorem taxes yield unstable revenues, as revenue fluctuates with the price (for example, 20 per cent of a $1.00 bottle yields $0.20 in tax revenue; whereas, if the price of the bottle declined to $0.90, a 20 per cent tax would only yield $0.18 in tax revenue).34 In essence, the government subsidizes industry price cuts (that is, tax revenue declines) but benefits from industry price increases (that is, tax revenue increases). Ad valorem taxes are more likely to keep pace with inflation than specific taxes, assuming prices follow inflation trends. Ad valorem taxes may also induce ‘trading down’ to less expensive brands, and thus generate less revenue. Finally, on the basis of experiences with cigarette taxes, ad valorem taxes require strong tax administrative systems because of the potential for abusive transfer pricing to avoid taxes. (If the tax is imposed at the manufacturer level, manufacturers can set artificially low prices, pay a low tax, and then raise prices later in the distribution chain.)34

Like an excise tax, the VAT is usually built into the shelf price seen by consumers, but because the VAT is applied at each stage strong administrative systems are required to ensure that the tax is paid at each stage. VAT also is subject to the same limitations as ad valorem taxes generally (as described above).

(ii) What types of beverages to tax?

Options to consider when determining what types of beverages to tax – include taxing: (i) only SSBs; (ii) all sweetened beverages; (iii) all/most beverages; or (iv) selected beverages. SSBs include all beverages for liquid consumption sweetened with caloric sweeteners including, but not limited to, calorically sweetened carbonated beverages, ready-to-drink (RTD) packaged teas/coffees, isotonic beverages or sports drinks, energy drinks, less than 100 per cent juice and fruit drinks, and calorically sweetened waters.28 In choosing to tax only SSBs, governments may decide to tax all SSBs or only selected SSBs (for example, only calorically sweetened carbonated beverages).

Or they may choose to tax all sweetened beverages, including both SSBs and artificially sweetened beverages (ASBs). ASBs are sweetened with noncaloric sweeteners (for example, aspartame, saccharin, or sugar substitutes) and include, but are not limited to, diet/no-calorie beverages and artificially sweetened RTD packaged teas/coffees, 0-calorie isotonic beverages, artificially sweetened less than 100 per cent juice drinks, and no-calorie, sweetened waters.

Alternatively, policymakers may opt to tax all beverages, regardless of sweetener, including SSBs, ASBs, 100 per cent juices, and bottled water or selected beverages (for example, all carbonated beverages and all juices with <100 per cent juice drinks). A jurisdiction need not tax all beverages at the same rate (see Table 1).

Besides the specific type of beverage, taxes may vary based on the beverage preparation method (for example, syrup, powder/mix). Sales taxes, however, are generally applied based on quantity (for example, gallons of syrup, per teaspoon of added sugar, per ounce, or gallons of beverage produced from the base product/mix).

(iii) What tax rate will affect consumption and obesity prevention-related revenue generation?

Given the link between SSB consumption and caloric intake,6, 7, 35 an SSB-specific tax would reduce SSB consumption more than a more broadly based beverage tax, as the SSB-only tax will encourage substitution to no/low calorie options.28, 33 Thus, SSB-specific taxes have the dual benefit of increasing the absolute price, while increasing the price of SSBs relative to no/low calorie beverages. At least one study has suggested that SSB-specific taxes might lead consumers to substitute to other, nontaxed high-calorie beverages (for example, full-fat milk) and, therefore, might have little effect on body weight.25 Yet, even if SSB-specific taxes had minimal impact on weight, they would reduce consumption of beverages with no nutritional value in favor of more nutritious or less caloric options. This would diminish some consequences of SSB consumption, including dental caries and diabetes.

We know that the larger the tax or relative price increase, the larger the impact on consumption, health-related outcomes and costs, and revenue generation (particularly in the beginning).12, 26 Public health experts have called for a $.01 / ounce tax on SSBs to reduce US consumption.11 Andreyeva and colleagues estimate that such a tax would reduce US SSB consumption by 24 per cent and generate over $79 billion in new revenue between 2010 and 2015, available for obesity prevention programming.28 An ad valorem tax equal to a 1 cent / ounce specific tax (for example, 20 per cent of the price) would have similar effects. A specific or ad valorem tax resulting in lower overall prices would have less of an effect on consumption, health outcomes, and revenues.

Examples of Beverage Taxation Approaches

We highlight here approaches to beverage taxation globally, presenting examples based on the type of tax: excise, sales, or VAT.

Approach 1: Excise or equivalent beverage taxes/fees

To date, no US jurisdiction has enacted an SSB-specific excise tax, although many have attempted to do so. Most proposals have included language that would dedicate a portion of the revenue generated to fund obesity prevention efforts.13, 36, 37 Seven states in the United States – Alabama, Arkansas, Rhode Island, Tennessee, Virginia, Washington, and West Virginia – and the cities of Chicago and Baltimore do, however, apply excise and equivalent taxes/fees to a broad spectrum of SSB and ASB beverage bottles, syrups, and powders/mixes at the manufacturer, wholesaler, distributor, and/or retailer levels. No revenues have been dedicated to obesity prevention (see Table 4).20, 38, 39, 40

Table 4 Current nonsales taxes on beverages in the United States (as of 1 January 2013)

Several countries, see Table 5, have adopted beverage excise or similar taxes/fees including, but not limited to, Algeria,41 Samoa,15, 18 Belgium,14 Denmark,14 Fiji,42 Finland,14 France,43 French Polynesia,15, 18 Guatemala,44 Hungary,41, 45 Latvia,14 Nauru,15, 18 and Norway (Customs Region Oslo and Akershus Information Office, personal communication, 25 October 2012). These taxes vary greatly by what beverages are taxed. Some tax only soft drinks, whereas others tax all sweetened beverages. They also vary by the type of tax applied (specific versus ad valorem). We do not know whether any country dedicates the revenues for obesity prevention.

Table 5 Examples of non-US beverage tax approaches

Approach 2: Sales taxes on beverages

The second approach applies a sales tax, a percentage of the retail price. We are not aware of any government that applies a sales tax only to SSBs. Sales taxes are generally applied to both SSBs and ASBs as in states in the United States that currently apply small taxes to sodas, soft drinks, and other beverages (see Table 1). These sales taxes use several approaches, including (i) sales taxes applying to all items sold; (ii) by not including soft drinks (or similar beverages) in the sales tax exemption for food products; or (iii) as sales taxes applying to a wide variety of beverages. (Additional information on state taxes and definitions is available at www.bridgingthegapresearch.org/research/sodasnack_taxes/.)

Approach 3: VAT on beverages

We know of no government with a SSB-specific VAT, a VAT, or VAT-like tax (for example, GST or HST), but many tax a broad range of beverages (see Table 5). Australia,46 Canada47, Fiji42 Ireland,48 and other European Union countries49 all apply a VAT or VAT-like tax (for example, GST or HST) to beverages. These VAT and VAT-like taxes are applied ad valorem, like the excise and sales taxes, but no country currently restricts the VAT to SSBs.

The European Union’s VAT Directive requires member states to apply a standard rate of at least 15 per cent, but allows a reduced rate for certain categories of goods and services (for example, nonalcoholic beverages are eligible for a reduced VAT).50 Data from 1 July 2012 indicate that VAT rates applied to SSBs such as lemonade and fruit juices (unspecified) vary greatly by European Union member countries – ranging from a low of 3 per cent in Luxembourg to a high of 27 per cent in Hungary (with a mean and median VAT of 16 per cent and 20 per cent, respectively).49 No data exist on whether the VAT applies to other SSBs or ASBs in European Union countries, although mineral waters are taxed at the same rate as lemonade and fruit juices in all member countries except for Cyprus, Poland, and Portugal: Cyprus applies a 17 per cent VAT on mineral water but only a 5 per cent VAT on lemonade and fruit juices; Poland applies a 23 per cent VAT on mineral water and lemonade but only a 8 per cent VAT on fruit juices; and Portugal applies a 6 per cent VAT on mineral water but a 23 per cent VAT on lemonade and fruit juices.49

Summary

Governments have several beverage taxation options. In addition to choosing the type and the amount of the tax to apply (both of which will differentially affect price, consumption, health, and revenue outcomes), governments must also decide what types and forms of beverages to tax. From a public health perspective, governments should consider the options that will lead to the greatest overall price increases for SSBs while incentivizing or making healthy options (such as bottled water and 100 per cent juice) more affordable in comparison to SSBs.11, 26, 28 Ultimately, the type of tax (specific excise tax), how broadly it is applied (all SSBs rather than just some), and how large it is (enough to raise the price significantly) will determine its impact. Ideally, the SSB taxes will be large enough to generate substantial initial revenue for obesity prevention programs, reduce SSB consumption, and improve health outcomes.

Of course, the proposals will remain just that (proposals) unless the public health and advocacy communities find ways to counter the stiff political and financial opposition from the beverage industry. (We described above recent actions in Denmark and California.) Two key strategies that may help garner support is to: (i) frame policies as revenue-generating and (ii) identify health care expenditure savings (for example, reduced insurance claims for diabetes) resulting from such taxes.51 In 2011, France took this approach and passed a beverage tax that was expected to raise 280 million euros ($389 million) in 2012 alone, with one-half of the funds slated for obesity prevention and the remainder to lower social taxes on farm labor.52 At the same time, 2012 polling data from California indicated that 57 per cent of voters polled said that, if approved by the majority of the state’s voters, they would support giving local governments the authority to tax products like alcohol, tobacco, junk foods, or sweetened beverages to help pay for obesity prevention programs.53 In Vermont, 2011 polling data indicated that 49 per cent of those polled supported a tax on SSBs as one approach to the state’s budget deficit.54 Yet, a 2012 US national poll from Harris Interactive indicated that only 38 per cent of those polled would support a new tax on soft drinks with a high sugar content for improving health and safety.55 Clearly, the public is divided on its support for this issue.

Research is needed to dispel industry-sponsored claims that there will be substantial regional job losses due to SSB taxes.56 Tobacco companies made similar misleading arguments in opposition to tobacco taxes, but they were subsequently refuted by independent research.57

It is critical that proposals for beverage taxes be carefully crafted and advanced. Without policy proposals on the decisional agenda, the possibility of such taxes and the associated revenue generation and broader public health impacts will diminish to nonexistant.