The relationship between the price and demand of alcohol, tobacco, unhealthy food, sugar-sweetened beverages, and gambling: an umbrella review of systematic reviews
Systematic Review
What the study is about
This study brings a fresh perspective at how prices impact not just one harmful behavior, like alcohol or smoking, but several at once, including unhealthy food and sugary drinks (SSBs).
The study provides illustrations from the UK and the US to show how taxes on health harmful products shape consumption behavior.
This umbrella review aimed to identify and summarise evidence from systematic reviews that report the relationship between price and demand or price and disease/death for alcohol, tobacco, unhealthy food, and SSBs. Given the recent recognition of gambling as a public health problem, the researchers also included gambling.
Key takeaways
The researchers identified 50 reviews from 5,185 records, of which 31 reported on unhealthy food or SSBs, nine reported on tobacco, nine on alcohol, and one on multiple outcomes (alcohol, tobacco, unhealthy food, and SSBs).
The researchers did not identify any reviews on gambling.
Higher prices were consistently associated with lower demand, notwithstanding variation in the size of effect across commodities or populations.
Reductions in demand were large enough to be considered meaningful for policy.
When prices go up, people generally buy health harmful products and services less and less.
The umbrella review found that a 10% price increase meant the following change in behavior:
- About 9% less SSBs were bought.
- About 6% less unhealthy food were bought.
- About 5% less tobacco products were bought,
- and 1% less alcohol products were bought.
Increases in the price of alcohol, tobacco, unhealthy food, and SSBs are consistently associated with decreases in demand. Moreover, increasing taxes can be expected to increase tax revenue.
There may be potential in joining up approaches to taxation across the harm-causing commodities.
Key results of syntheses
The relationship between price and demand
The included systematic reviews find that increases in the price of alcohol, tobacco, unhealthy food, or SSBs are associated with decreases in demand, notwithstanding variation in the size of effect across commodities or populations.
An inverse association between price and demand was consistently seen across all outcomes.
Looking across the included meta-analyses, a 10% increase in product price was associated with a median reduction in demand of 9.1% for SSBs, 6.0% for unhealthy food, 5.4% for tobacco, and 1.4% for alcohol.
It should be noted that there will be overlap in the studies contributing to these estimates which the researchers did not quantify. Where reviews reported the differential impact of price on different groups, the evidence generally suggests that more deprived groups are more price responsive than less deprived groups.
The relationship between price and disease or death
Compared to the body of evidence reporting the relationship between price and demand, the body reporting the relationship between price and disease/death was smaller.
Across the alcohol reviews, inverse relationships were most consistently seen for outcomes which are wholly caused by alcohol (those with an alcohol attributable fraction of 1), such as alcohol-related liver disease or alcohol dependence.
Meaning of the research findings
Despite alcohol and tobacco being taxable commodities for centuries, we identified fewer reviews in these areas compared to reviews on unhealthy food and SSBs which have only recently been viewed as taxable commodities.”
Burton, R., Sharpe, C., Bhuptani, S., Jecks, M., Henn, C., Pearce-Smith, N., Knight, S., Regan, M., & Sheron, N. (2024). The relationship between the price and demand of alcohol, tobacco, unhealthy food, sugar-sweetened beverages, and gambling: an umbrella review of systematic reviews. BMC Public Health, 24(1286).
The researchers undertook a comprehensive umbrella review of systematic reviews to identify the relationship between the price of alcohol, tobacco, unhealthy food, SSBs, or gambling, and demand or disease/death.
Despite alcohol and tobacco being taxable commodities for centuries, the researchers identified fewer reviews in these areas compared to reviews on unhealthy food and SSBs which have only recently been viewed as taxable commodities.
Such consistency in findings clearly highlights the fundamental role of tax as a public health policy.”
Burton, R., Sharpe, C., Bhuptani, S., Jecks, M., Henn, C., Pearce-Smith, N., Knight, S., Regan, M., & Sheron, N. (2024). The relationship between the price and demand of alcohol, tobacco, unhealthy food, sugar-sweetened beverages, and gambling: an umbrella review of systematic reviews. BMC Public Health, 24(1286).
This comprehensive umbrella review clearly demonstrates that, at the most basic level, price interacts with income to affect demand, such that price increases of alcohol, tobacco, unhealthy food, or SSBs are linked with reductions in demand.
Such consistency in findings clearly highlights the fundamental role of tax as a public health policy.
Our review suggests that a 10% increase in product price is associated with reductions in demand in the order of 9% for SSBs, 6% for unhealthy food, 5% for tobacco, and 1% for alcohol. This inverse relationship was most consistently seen for alcohol, and least consistently for SSBs. The relationship between price and demand was seen among adult and child populations, with some review-level evidence to suggest that children and young people were more price responsive in the case of tobacco, as might also be the case for SSBs, although most reviews did not explicitly make this comparison.
Although most reviews included research from high-income countries, where studied, the inverse price-demand relationship was seen across low-, middle-, and high-income countries. There was a lack of research on heavy consumers. Although the reviews present a consistent overall picture of the impact of price/tax on demand, there was large variation in estimates across the individual studies which may relate to methodological differences across studies. Elasticity estimates also vary over time, with some suggestion that products have become less price elastic, which probably reflects increasing affluence as products become more affordable.
No alcohol reviews included evidence that lower income, education, or socioeconomic status groups were more price responsive compared to their less deprived counterparts for example. Nonetheless, data from primary research studies suggests that more deprived alcohol users are more price responsive.
A common argument against the imposition of taxes is that they may have a proportionally greater financial impact on people with lower incomes relative to those with higher incomes. However, lower income groups as a whole reap greater health benefits. To the extent that lower income individuals are more price sensitive, they will be more likely to cut back on the intake of taxed commodities, often starting from a higher level of consumption, and thus experience greater health gains.
Health and revenue benefits
Raising taxes not only has direct public health benefits but can also generate considerable revenue for governments. If price increases do not respond proportionately to tax increases, government revenue will increase when taxes increase because the decrease in consumption is more than offset by the extra tax paid by those who continue to purchase the taxed product.
This review suggests this is the case for alcohol, tobacco, and unhealthy food, however some of the PED estimates for SSBs exceed one, suggesting government revenue might reduce because of the greater demand response. Nonetheless, SSB taxes are not widely implemented so any revenue generated by their introduction is revenue that would not have otherwise existed.
Increased revenue associated with tax increases may go some way in compensating for the societal and human costs associated with alcohol, smoking, and excess weight.
High-risk alcohol use, smoking, and excess weight, commonly co-occur and cluster in the most deprived. Multiple risks also result in large risks of disease or death which are synergistic in the case of alcohol and excess weight for liver disease and alcohol and smoking for oral cancers. From these perspectives (behavioural and clinical), there is clear rationale for joining up policy approaches to prevent and reduce harm. The results of this review further highlight the potential of joining up policy approaches, specifically taxation and price increases. While taxation shares the same mechanism of action for alcohol, tobacco, unhealthy food, and SSBs, it should be noted that the end-goal of policy implementation might differ. An appropriate goal for smoking is usually complete abstinence, whereas for alcohol, the aim is to decrease the number of people consuming alcohol at levels which increase their risk of health harm (noting abstinence might be the goal for people with alcohol dependence). Although the WHO have recently recognised that there is no safe level of alcohol consumption, in practice, most countries have developed low-risk drinking guidelines at levels above zero which are typically set at what is considered to be an acceptable level of risk.
While this umbrella review has demonstrated the effectiveness of tax as a public health measure for alcohol, tobacco, unhealthy food, and SSBs in isolation, it has not been able to explore the impact of simultaneous tax increases across these commodities, namely because the evidence does not exist. Future research should aim to understand the potential public health impact of a holistic approach to tax policy spanning these commodities.
Study conclusion
While alcohol consumption, smoking, and excess weight all represent a substantial public health burden in and of themselves, there are clear behavioural, clinical, and policy synergies across these risks. The evidence supports tax/price increases as effective policies for reducing demand, which suggests there might be merit in a joined-up approach to tax, with the treasury representing an arbiter of public health and the National Health Service (NHS) costs.
Abstract
Background
The WHO highlights alcohol, tobacco, unhealthy food, and sugar-sweetened beverage (SSB) taxes as one of the most effective policies for preventing and reducing the burden of non-communicable diseases. This umbrella review aimed to identify and summarise evidence from systematic reviews that report the relationship between price and demand or price and disease/death for alcohol, tobacco, unhealthy food, and SSBs. Given the recent recognition of gambling as a public health problem, the researchers also included gambling.
Methods
The protocol for this umbrella review was pre-registered (PROSPERO CRD42023447429). Seven electronic databases were searched between 2000–2023. Eligible systematic reviews were those published in any country, including adults or children, and which quantitatively examined the relationship between alcohol, tobacco, gambling, unhealthy food, or SSB price/tax and demand (sales/consumption) or disease/death. Two researchers undertook screening, eligibility, data extraction, and risk of bias assessment using the ROBIS tool.
Results
The researchers identified 50 reviews from 5,185 records, of which 31 reported on unhealthy food or SSBs, nine reported on tobacco, nine on alcohol, and one on multiple outcomes (alcohol, tobacco, unhealthy food, and SSBs).
The researchers did not identify any reviews on gambling. Higher prices were consistently associated with lower demand, notwithstanding variation in the size of effect across commodities or populations. Reductions in demand were large enough to be considered meaningful for policy.
Conclusions
Increases in the price of alcohol, tobacco, unhealthy food, and SSBs are consistently associated with decreases in demand. Moreover, increasing taxes can be expected to increase tax revenue. There may be potential in joining up approaches to taxation across the harm-causing commodities.