early impacts of the uk soft drinks industry levy on the...

MRC Epidemiology Unit

Early impacts of the UK Soft Drinks Industry Levy on the food system and public health South West Public Health Conference, 19th March 2019 Prof Martin White Centre for Diet & Activity Research, MRC Epidemiology Unit


The Study Team

Dr Peter Scarborough

Prof Mike Rayner Dr Richard Harrington

Prof Richard Smith Prof Steven Cummins Dr Harry Rutter

Prof Martin White Dr Jean Adams

Dr Oliver Mytton

Dr Adam Briggs

Vyas Adhikari

Lauren Bandy

Dr Marcus Keogh-Brown

Dr Henning Tarp-Jensen

Cherry Law

Dr Tarra Penney

David Pell

Hannah Forde

Dr Linda Cobiac


The Soft Drinks Industry Levy

• National policy designed by HM Treasury

• To encourage reformulation - a two-tiered levy on large* manufacturers and importers of identified soft drinks**

• Approximately 2 years between announcement to implementation, each event likely to have impacts

• Promise that funds raised from levy will fund children’s health initiatives (e.g. school sports and healthy school breakfast clubs)

Exemptions * <1 million liters per year ** <5g/100ml of added sugar, milk based drinks, pure fruit juices, alcohol


Context and timeline

• 2015 May – WHO recommends Fiscal policies to improve diet and prevent NCDs

• 2015 July – The Scientific Advisory Committee on Nutrition Report on Carbohydrates and Health endorses WHO recommendations

• 2015 Sept – Jamie Oliver Sugar Rush documentary on Channel 4 + Restaurant SSB levy

• 2015 Oct – Jamie Oliver attends Health Select committee + Sugar Reduction Report from PHE

• 2016 Mar - Levy Announcement

• Ongoing media coverage

• 2018 April – Levy Implementation


Simplified value chain of soft drinks industry

Syrup producer Bottler, Manufacturer,

Importer

Distributor Retailer Consumer

Imposed at point of production or importation

Simplified soft drinks industry supply chain

Aim: Reduction of sugar consumption in population

Primary mechanism: reformulation, not price change


Initial research: rapid funding grant from NIHR

1. Evidence review, theorising and system mapping

2. Stakeholder consultation for organisational view – verification of map using online Delphi

3. Mapping of data sources to system map to determine viability of experimental design

4. Establish baseline data collection from non-routine sources

• Qualitative interviews with stakeholders

• Governmental discourse

• News and social media discourse on sugar and the SDIL

• Public attitudes to sugar and SDIL

5. Develop protocol and grant application for evaluation


Initial system map – input to system mapping workshop

Chancellor’s announcement

Pre-announcement

advocacy

Excise levy on SSBs

Δ Media & public discourse

Δ public attitudes, awareness & social

norms re SSBs

Reformulation of existing products

Development of new products

↑ Price of SSBs

Δ price of other products

↓ purchasing of SSBs

Δ purchasing of other products

Δ whole diet composition

Δ acute & chronic disease

risk factors

Δ acute & chronic health

outcomes

↑ funding for school sports

↑ funding for school breakfast

Δ physical activity

Δ in other health behaviours

Δ food sector profits

Δ food sector employment

Δ marketing of SSBs & other

products


Revised system map – input to online Delphi


Final UK SDIL system map and data sources


Priority Data Sources identified from System Map


SDIL evaluation design

5 work packages over 3 two-year time periods (2014-20). 1. Interrupted time series analyses to evaluate impacts of the SDIL

on: • Soft drink product diversification, formulation & price,

marketing, purchases, consumption • Prevalence of childhood obesity & hospital admissions for

severe dental caries 2. Modelling health outcomes over short (5 years), medium (5-10

years) & long term (>10 years). 3. Micro-economic & macro-economic evaluation to assess wider

impacts of SDIL on industry, households, Treasury and UK economy

4. Qualitative methods to determine the perceived acceptability & impacts of the SDIL - interviews with professionals & the public, thematic content analysis of news articles & social media (twitter), governmental discourse

5. Regular updating of systems map, integration and synthesis of findings from WPs1-4 , refinement of intervention theory.

Prior to announcement Apr 2014- Mar 2016

Announcement to implementation Apr 2016- Apr 2018

Following implementation Apr 2018- Mar 2020


Work package 1a: impact on market diversity, sugar content and price Lead: Dr Peter Scarborough Nuffield Department of Population Health, University of Oxford

The impact of the SDIL on sugar content

1. Retrospective data collection a) 4 major supermarkets, 68% of market share b) Data from 1st of each month from August 2015 to

September 2018 (38 time points) c) Sugar content, ingredients, volume, price of all soft

drinks (n~4000) d) Controlled interrupted time series analysis

2. Prospective data collection a) Custom built web scraping and data management

software b) Data for 1 month before (from 9th march 2018) and

one month after implementation of SDIL (from 11th May 2018)

c) Sugar content, ingredients, volume, price of all soft drinks from 7 major supermarkets with online sales

d) Sankey plots, plus logistic regression and Chi-squared analyses

BrandView


Evidence of varied industry reactions


Next steps

1. Controlled interrupted time series investigating: i. Price (and pass-through rate) ii. Market diversity (e.g. rate of new product entries in each levy

category) iii. Portion sizes

2. Follow-up time series analysis with extra six months (i.e. up to March 2019), to explore whether fall in sugar content has plateaued

3. Further follow up March 2020


Work package 1b-d: Impact on purchases and consumption of SSBs, and early health impacts Lead: Dr Jean Adams Centre for Diet & Activity Research, MRC Epidemiology Unit


Research questions

Was the announcement or implementation of the SDIL associated with a change in:

• Purchases of: drinks, a high-sugar substitute (confectionery), an unrelated category (toiletries)?

• Commercial household purchasing data • Consumption of: drinks, confectionary, total free sugars?

• Nutritional surveillance data • Prevalence of: childhood obesity, hospital admissions for dental

caries? • Childhood obesity surveillance data; hospital admission data


Purchasing – data & analysis

• Kantar WorldPanel • commercial household purchase panel; n~30,000 households • All food & drink purchases brought home • Control categories (confectionary, toiletries)

• Interrupted time series analysis

• 2y before to 2y after SDIL announcement (n=208 data points) • Purchases per household per week

• L of drinks; kg of confectionary; packs of shampoo • Adjusted for: autocorrelation, January, December, Christmas

week, Easter week, average monthly temperature


Work package 3: Economic impacts on food and other industries, HM Treasury, health and social care Lead: Prof Richard Smith Exeter University and Faculty of Public Health and Policy, LSHTM


Stock market reaction to SDIL announcements

• Aim: to investigate the ‘market reaction’ to the SDIL via the stock market value of UK soft drink firms

• Method: Event study methodology is used to calculate the difference between the actual stock returns and the expected returns if the events did not occur.

• Announcements (events) studied: • SDIL announcements on 16th March 2016 • Release of draft legislation and consultation summary on 5th

December 2016 • Confirmation of SDIL rates on 8th March 2017

• Data: Closing stock price data of all UK-operating soft drink firms listed on London Stock Exchange (i.e. A.G. Barr, Britvic, Fever-tree and Nichols


Work package 4: Impacts on key stakeholders Lead: Prof Martin White Centre for Diet & Activity Research, MRC Epidemiology Unit


Impacts on key stakeholders

Purpose

• To determine the acceptability and perceived impacts of the SDIL among key stakeholders, including the public, policy makers and professionals in industry and health sectors.

Specifically, to examine

• Food industry reactions and discourse

• Political discourse and advocacy

• Media discourse

• Public reactions


Methods – overall

Data collection • Industry trade press and print newspapers

• Factiva database, search strategy and screening of articles for relevance

• Government documents • Hand searching government websites

• Hansard (official record of Parliamentary sessions), select committee records and other key documents from relevant departments (e.g. HM Treasury, Department of Health)

• Interviews and focus groups • Telephone interviews with stakeholders from

academia, public health, civil society, government and industry and adult members of the public

• Focus groups with secondary school children Analysis • Thematic content or critical discourse analysis,

cross-sectional or longitudinal, will be used as appropriate


Early results – Industry reactions to the announcement of the SDIL

• Purpose: To develop a detailed understanding of the evolution of industry reactions to the levy from announcement to implementation, via articles published in news media and trade press.

• Methods: Identification and screening of media and trade press articles via Factiva database using search terms and inclusion criteria

• Analysis: Longitudinal, case-based, thematic analysis of each identified industry actor


Article characteristics and industry actors

• 526 articles were included covering the ongoing reactions from March 16th 2016 to April 6th 2018

• Nine industry actors reacting to the levy were found to contribute to the discourse on at least one occasion

• AG Barr, Britvic, Coca-Cola European Partners, Nichols, NixKix, Ribena, Tesco, Waitrose and SPAR

• Three actors dominated the discourse, throughout (~77% articles)


SDIL evaluation: next steps

• Publish papers on impacts of announcement of levy (April 2014-March 2018)

• Update analyses from each work stream to March 2019 (one year post-implementation) and publish papers on early impact of legislation

• Update analyses to March 2020 to assess longer terms impacts of legislation (2 years post-implementation)

• Conduct modelling of medium to long term impacts of the levy on health outcomes

• Integrative analysis and synthesis of findings from WPs 1-4 to draw overall conclusions on impacts of the levy and derive generalisable learning

• Review and revise system map


Acknowledgements The evaluation of the SDIL has been funded by NIHR Public Health Research Programme, grants 16/49/01 and 16/130/01.

MW is funded as Director of the NIHR PHR Programme.

All of the investigators receive funding from the public and charitable sectors. None of the investigators receive any funding from any commercial entities.

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