The Health and Economic Impact of Using a Sugar Sweetened Beverage Tax to Fund Fruit and Vegetable Subsidies in New York City: A Modeling Study

Abstract

Low fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are independently associated with an increased risk of developing cardiovascular disease (CVD). Many people in New York City (NYC) have low FV intake and high SSB consumption, partly due to high cost of fresh FVs and low cost of and easy access to SSBs. A potential implementation of an SSB tax and an FV subsidy program could result in substantial public health and economic benefits. We used a validated microsimulation model for predicting CVD events to estimate the health impact and cost-effectiveness of SSB taxes, FV subsidies, and funding FV subsidies with an SSB tax in NYC. Population demographics and health profiles were estimated using data from the NYC Health and Nutrition Examination Survey. Policy effects and price elasticity were derived from recent meta-analyses. We found that funding FV subsidies with an SSB tax was projected to be the most cost-effective policy from the healthcare sector perspective. From the societal perspective, the most cost-effective policy was SSB taxes. All policy scenarios could prevent more CVD events and save more healthcare costs among men compared to women, and among Black vs. White adults. Public health practitioners and policymakers may want to consider adopting this combination of policy actions, while weighing feasibility considerations and other unintended consequences.

Keywords: Economic evaluation; Food policy; Policy modeling; Urban health.

Fig. 1

Model schematic. Notes: CHD, coronary heart disease; CVD, cardiovascular disease

Fig. 2

Projected long-term clinical and economic outcomes compared with the status quo (numbers of CHD and stroke events, QALYs, and healthcare costs per 10,000 adults in NYC over 10, 20, and 40 years and lifetime were reported). Notes: SSB, sugar sweetened beverage; FV, fruit and vegetable; CHD, coronary heart disease; CVD, cardiovascular disease; QALY, quality-adjusted life year

Fig. 3

Incremental costs and quality-adjusted life years compared with the status quo. Notes: The red dashed line is the $50 k/QALY cost-effectiveness threshold. SSB, sugar sweetened beverage; FV, fruit and vegetable; QALY, quality-adjusted life year