Table_6_Systematic review on fiscal policy interventions in nutrition.docx

IntroductionBoth the World Health Organization and the Lancet Series on Adolescent nutrition recommend that governments adopt fiscal policies to combat diet-related non-communicable diseases (NCDs). However, rigorous, systematic evidence regarding the effects of these interventions is lacking.
MethodsWe synthesize the available evidence regarding the impacts of taxes and subsidies that directly affect consumer prices on availability and accessibility of foods and beverages, purchasing behavior, diet quality, health and well-being outcomes as well as considerations for implementation, sustainability and equity.
ResultsOur initial search returned 2,113 de-duplicated studies, and ultimately 24 impact evaluations and two systematic reviews met final eligibility criteria and represented unique evaluations. Our meta-analysis of these studies suggests that taxes may decrease purchases of taxed beverages (SMD = −0.14 [95% CI: −0.29 to −0.07], n = 15). Results should be interpreted cautiously due to considerable heterogeneity (Q(14) = 335.19, p = 0.01, τ^2=0.03, I2 = 95.82%).
DiscussionThe evidence base is too limited to draw conclusions about the effects of taxes on beverages and calorie-dense foods on purchases, or on the effects of subsidies on purchasing or diet quality. Overall, the evidence base is inconclusive on whether fiscal policies can meaningfully influence the availability and accessibility of foods and beverages, diet quality, and health outcomes. Policymakers implementing fiscal policies should consider information campaigns on health benefits and health risks associated with certain food and beverage consumption. For taxes, exposure to health information may amplify signaling effects of taxes and reduce avoidance behaviors, such as cross-border shopping. Future evaluations should diversify data sources to better understand impacts on diet and health outcomes.

引言 世界卫生组织（World Health Organization）与《柳叶刀》青少年营养系列专题均建议各国政府采用财政政策，以防控与膳食相关的非传染性疾病（non-communicable diseases, NCDs）。然而，目前仍缺乏针对此类干预措施效果的严谨系统证据。

方法 本研究整合了现有证据，涵盖直接影响消费者价格的税收与补贴政策对食品饮料可得性、可及性、购买行为、膳食质量、健康与福祉结局的影响，以及政策实施、可持续性与公平性等相关考量因素。

结果 本研究初步检索共获得2113篇去重后的文献，最终有24项影响评估与2项系统综述符合最终纳入标准，且均为独立评估。对上述研究的荟萃分析结果显示，税收政策或可降低征税饮料的购买量（标准化均数差（Standardized Mean Difference, SMD）= −0.14，95%置信区间（95% Confidence Interval, 95% CI）：−0.29 ~ −0.07，n=15）。由于存在显著异质性（Q(14)=335.19，p=0.01，τ²=0.03，I²=95.82%），解读本研究结果时需谨慎。

讨论 目前现有证据仍不足以得出税收政策对饮料及高能量密度食品购买量的影响，或补贴政策对购买行为与膳食质量的影响等明确结论。总体而言，现有证据无法明确财政政策能否有效影响食品饮料的可得性与可及性、膳食质量及健康结局。实施财政政策的政策制定者应考虑开展健康宣传活动，向公众普及特定食品饮料消费相关的健康益处与健康风险。对于税收政策而言，公众接触健康信息或可强化税收的信号效应，并减少跨境购物等规避行为。未来的评估应拓宽数据来源，以更全面地解析政策对膳食与健康结局的影响。