Health Behaviour and Prevention

Einleitung / Introduction

Overweight and obesity is caused to a large extent by overconsumption of sugar, in particular sugar-sweetened beverages (SSBs). The WHO therefore recommends taxing SSBs and by 2019 already 39 countries worldwide have introduced soda taxes, in addition to a number of cities and counties in the US. Many governments tax the SSB by a tax rate applied to each volume unit (e.g. ounce or litre) of the SSB. But very recently, taxes on the sugar content of SSBs have become more and more popular. In 2018, for instance, the UK introduced a soft drink tax with a rate of 18p per litre on SSBs with 5-8g sugar per 100ml and 24p per litre on SSBs with more than 8g sugar per 100ml. Soda taxes with a similar rate structure are implemented in Chile, Portugal and France. The present paper provides a new economic foundation for taxes on SSBs, in particular taxes on the sugar content of SSBs, and additionally shows that such taxes have to be supplemented by a revenue-neutral subsidy (!) on each volume unit of the SSBs.

Methode / Method

The results are derived in a theoretical general equilibrium model with sugar production, SSB production and SSB consumption. Each unit of the SSB contains a certain amount of sugar that explicitly enters the analysis as production factor. The embodied sugar per unit of SSB output, called sugar content, is a product characteristic that can be varied in the SSB production process. The consumer has preferences regarding the quantity and the sugar content of the SSB, and she is harmed by the sugar intake stemming from SSB consumption. Within this framework, we compare the Pareto efficient allocation with the market outcome and identify optimal regulatory instruments in case markets fail.

Ergebnisse / Results

We emphasize that in practice markets and prices for sugar content cannot be expected to emerge. This argument is key to our analysis and empirically supported by the evidence ’uniform product pricing’, according to which an SSB and its zero-sugar variant are usually sold at the same price. As consequence of missing markets for sugar content, in the absence of any regulation, the sugar content is inefficiently high. This market failure can be corrected by a tax on the sugar content per unit of the SSB. However, as the sugar content tax applies to each unit of the SSB, tax payments increase with the quantity of the SSB. This leads to an unintended downward distortion of the SSB quantity, which has to be corrected by the additional revenue-neutral subsidy on each volume unit of the SSB. The same tax-subsidy solution applies if we have several SSB variants, where the SSB-specific sugar content taxes may be replaced by a uniform tax function that is increasing and convex in the sugar content and can also easily be used to compute the optimal subsidy on the SSB demand of consumers.

AutorInnen

Thomas Eichner, Fernuniversität Hagen

Marco Runkel, Technische Universität Berlin

Einleitung / Introduction

Objective: For many individuals, a sufficient and sustained level of physical activity is difficult to achieve. This systematic review evaluates the effectiveness of behavioural economics (BE)-informed strategies for increasing an individual’s level of physical activity in the long-term.

Methode / Method

Methods: We conducted a systematic literature search using Medline (via PubMed), PsycInfo, and EconLit. We included randomized controlled trials that evaluated BE-informed interventions to promote physical activity. Potential elements of the BE approaches were commitment devices, social incentives, motivational feedback, goal setting, gamification, and financial incentives. Among others, extracted outcomes included different measures of physical activity (e.g., step count). Risk of bias was assessed using the revised Cochrane risk-of-bias tool for (cluster-) randomized trials. A random-effects meta-analysis was conducted for the outcome measure daily step count.

Ergebnisse / Results

Results: Based on 14 studies with 4328 participants, the BE-informed interventions most often applied were commitment lotteries (n = 8) and social incentives (n = 7). Risk of bias assessment classified five studies as low risk, eight studies as having some concerns, and one study as high risk of bias. Significant results on study level towards BE-informed interventions were observed for commitment lotteries (n = 3) and gamification (n = 4, combined with social incentives or goal setting). The meta-analysis (n = 9) indicated a significant increase in daily step count in the experimental groups compared to the control for both periods, i.e., standardized mean differences of 0.20 (p < 0.001, corresponding step increase = 612) and 0.13 (p = 0.004, corresponding step increase = 368) for the intervention and follow-up period, respectively.

Zusammenfassung / Conclusion

Conclusion: Our review reveals the potential of BE-informed interventions to promote physical activity. The overall small positive effect indicates, however, that it is important to understand the behavioural channels which may explain the heterogeneity in individuals’ responses to specific BE strategies.

AutorInnen

Helena Reisgies, Universität zu Köln

Arim Shukri, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln

Benjamin Scheckel, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln

Olaf Karasch, Universität zu Köln

Daniel Wiesen, Universität zu Köln

Stephanie Stock, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln

Dirk Müller, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln

Einleitung / Introduction

Breast Cancer is the most common cause of cancer mortality in women in Germany. Cancer screening aims to prevent cancer mortality. Participation rates vary across the EU with below-average take-up rates in Germany. In order to investigate potential channels of the decision to participate - social interactions and peer effects - we run a field experiment within the German National Mammography Screening Programme and evaluate take-up.

Methode / Method

First, we ran a representative survey that showed that mammographies are a topic of conversation among women of the relevant age group. Second, we implemented a cluster-randomized controlled trial on the geographical zip code- level in parts of one German state. For regions in the control group, the invitation algorithm remains unchanged and women from one ZIP code are invited to appointments that are scheduled across multiple weeks. In the treatment group, mammography appointments are bunched: The appointments of all women in a ZIP code are scheduled over the shortest feasible time period, e.g. all within three days. This parallel timing of receiving the letter and the appointments might lead to an increased probability of social interactions related to mammography. We analyze the effect of this treatment on screening participation conditional on previous participation and age. Supplementary surveys help us to evaluate the mechanisms behind potential treatment effects. Third, we use exogenous variation in the order of suggested appointments within a ZIP code to evaluate the effect of having appointments on a similar date as a spatially close peer woman on own participation. We can also control for the participation decision of those peers. We further document the degree of spatial correlation in mammography screening participation at a small geographical level.

Ergebnisse / Results

Our RCT is running until February 2023. Preliminary first results indicate modest positive peer effects. We find suggestive, yet not statistically significant, evidence that our treatment increases participation especially for women who did not participate previously.

Zusammenfassung / Conclusion

We evaluate the role of social interactions in preventive health care decisions in the context of Mammography Screening. We run a field experiment that increases the probability of social interactions related to mammography screening. First preliminary results suggest modest positive treatment effects.

AutorInnen

Peter Redler, LMU München

Friederike Reichel, LMU München

Einleitung / Introduction

After a significant increase in binge drinking of alcoholic mixed beverages, also called Ready-to-Drink-beverages (RTDs) by the industry, especially among adolescent girls in 2003, the German parliament passed the alcopop-tax, which came into effect in July 2004. The Alkopop tax tariff imposess a high excise tax per alcohol content on all beverages containing a mixture of spirits and with any other non-alcoholic softdrink . As a matter of fact the tariff is appliable only to mixed alcoholic beverages up to an alcohol content of 10 vol. %. Currently the alcohol industry is launching several new Ready-to drink-products on the market that contain exactly the alcoholic content at the tarriff boundary. This contribution aims to demonstrate two aspects: First the effectivenesss of the Alkopop-tax in curbing demand and reducing the associated health problem of alcoholic intoxicatinon among adolescents. And second, the call for political action given that the market for RTD-products is on the rise again due to the exploitation of the bounded Alkopop-taxt-tarriff,

Methode / Method

Using time-series data from the "Gesundheitsberichterstattung des Bundes" internet portal a segemented regression analysis within an interrupted time-series frame was undertaken to analyse the effect of the Alkopop-tax implementation on alcohol intoxifications among adolescents. Documents and statistics on tax incomes from the Alkopop tax were analysed for additional information.

Ergebnisse / Results

Regression results demonstrate a significant effect of the tax implementation on either the level of alcohol intoxications or the timetrend of intoxications but not both depending on the model used. These effects might be reversed and perished again with the rising volume of sold new cheap Ready-to drink-products in the next years.

Zusammenfassung / Conclusion

The results demonstrate that the German Alkopoptax implemented in 2004 was effective in reducing alcohol intoxication among adolescents. However due its bounded tariff at 10 vol% per beverage and the rising popularity of RTDs with an alcoholic content at this upper boundary and beyond not affected by the tax there is growing concern of a possible rise in adolescent binge drinking occasions again. A correction of the tax tarriff by extending it to beverages with more than 10% vol. with a smooth convergence to the regular spirit tax tarriff is needed to end the textbook.like tax evasion of the alcohol industry.

AutorInnen

Tobias Effertz