Estimated health impact, cost, and cost-effectiveness of taxation on unhealthy packaged foods in the Philippines: a modelling study

Affiliations

¹ Division of Economics, School of Social Sciences, Nanyang Technological University, Singapore.
² Department of Global Health, School of Health, Georgetown University, Washington, DC, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Resolve to Save Lives, Alexandria, VA, USA.
⁴ Department of Science and Technology-Food and Nutrition Research Institute, Manila, Philippines.
⁵ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁷ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. Electronic address: mmarklu1@Jhu.edu.

PMID: 40876471
DOI: 10.1016/S2468-2667(25)00191-4

Free article

Estimated health impact, cost, and cost-effectiveness of taxation on unhealthy packaged foods in the Philippines: a modelling study

Akshar Saxena et al. Lancet Public Health. 2025 Oct.

Free article

. 2025 Oct;10(10):e824-e834.

doi: 10.1016/S2468-2667(25)00191-4. Epub 2025 Aug 25.

Authors

Affiliations

¹ Division of Economics, School of Social Sciences, Nanyang Technological University, Singapore.
² Department of Global Health, School of Health, Georgetown University, Washington, DC, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Resolve to Save Lives, Alexandria, VA, USA.
⁴ Department of Science and Technology-Food and Nutrition Research Institute, Manila, Philippines.
⁵ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁷ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. Electronic address: mmarklu1@Jhu.edu.

PMID: 40876471
DOI: 10.1016/S2468-2667(25)00191-4

Abstract

Background: In 2018, the Philippines implemented a tax on sugar-sweetened beverages. A broader tax on unhealthy foods is being considered. We aimed to estimate the effect of a tax on unhealthy packaged foods.

Methods: In this modelling study, we used a multiple-cohort, proportional multistate life table model to estimate the effect of a 20% tax on packaged foods exceeding WHO thresholds for sodium or sugar, excluding beverages already taxed. Using nationally representative nutrition, sales, and Global Burden of Diseases, Injuries, and Risk Factors Study data, we projected changes in sodium and sugar intake and related health outcomes (cardiovascular disease and type 2 diabetes) and economic outcomes (health-care costs, tax revenue, and implementation costs) over 20 years, comparing Filipino adults aged 25 years and older in 2020 (reference population) with the same population under the intervention with reduced intakes from the tax, assuming 100% pass-through to prices. Cost-effectiveness was estimated from extended health-care and government perspectives and stratified by wealth quintile.

Findings: Compared with the base-case scenario (ie, the status quo), the tax was estimated to avert 2775 deaths (95% uncertainty interval 2685-2853), 13 632 incident ischaemic heart disease events (13 153-14 029), 5287 ischaemic strokes (5090-5445), and 21 763 type 2 diabetes cases (21 532-22 006) over 20 years, generating 326 253 health-adjusted life-years (321 577-330 434). The tax could be cost saving from the government perspective and cost-effective from the health-care perspective, with an estimated 2·37 billion Philippine pesos (PHP; 2·32-2·42) in health-care savings, PHP 647·99 billion (646·42-649·45) in tax revenue, and PHP 12·96 billion (12·93-12·99) in implementation costs over 20 years. Estimated health gains were concentrated among people in middle-income groups, whereas tax revenue increased with income.

Interpretation: A nutrient-based tax on unhealthy packaged foods could reduce diet-related disease burden and generate sustained tax revenue in the Philippines. These findings support nutrient-based food taxes as a cost-effective strategy to reduce disease burden, and raise revenue in low-income and middle-income countries.

Funding: Resolve to Save Lives funded by Bloomberg Philanthropies.

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Conflict of interest statement

Declaration of interests ADK reports grant support from Resolve to Save Lives in support of the present work; and grant support from WHO–Alliance for Health Policy and Systems Research, WHO–NCD Platform, Oak Foundation, GHR Foundation, Opioid Industry Document Archive, and Bloomberg Philanthropies–Bloomberg Initiative for Global Road Safety; and honoraria from Johns Hopkins University, all outside of the present work. LJA reports grant support from the National Institutes of Health, Sheikh Khalifa Stroke Institute, and Cigarette Restitution Fund of Maryland; consulting fees from GiveWell; and payments or honoraria from Wolters Kluwer, Cardiometabolic Health Congress Symposium, and Controversies to Consensus in Diabetes, Obesity and Hypertension, all outside of the present work. MM reports grant support from WHO and consulting fees from GiveWell, both outside of the present work. All other authors declare no competing interests.

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Estimated health impact, cost, and cost-effectiveness of taxation on unhealthy packaged foods in the Philippines: a modelling study

Affiliations

Estimated health impact, cost, and cost-effectiveness of taxation on unhealthy packaged foods in the Philippines: a modelling study

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

LinkOut - more resources

Full Text Sources