In October 2011 Denmark became the first country in the world to impose a tax on saturated fat. Although short-lived - it was scrapped by the next government in January 2013 - researchers from the University of Copenhagen and Oxford say it nevertheless improved the Danish diet, saving an estimated 123 lives per year.
Using shopping data taken from over 2500 households, they calculated saturated fat intake fell by 4.9% for middle-aged women and 1.6% for older men, with an average decrease of 4%. Consumption of total fat fell across almost all age groups, while vegetable consumption increased by 7.9% on average and fibre intake by 3.7%.
Of the 123 averted deaths, 76 were under 75 years of age.
However the tax also had the unintended, adverse effect of increasing salt intake for all groups except younger females. “Modelling the effect of the changes in diet on health outcomes suggests that the saturated fat tax made a positive contribution to public health in Denmark, with an estimated 123 averted deaths per year, of which more than 80% could be attributed to averted deaths from cardiovascular disease. The analysis, however, also demonstrates that it is important to consider unexpected adverse health effects due to substitution,” writes lead author Sinne Smed.
According to the researchers, an impact assessment of this kind should have preferably been carried out by the government before doing away with the tax, which was equivalent to 16 Danish krone per kilogram of saturated fat (€2.14 / kg). It was levied on foods with a saturated fat content of more than 2.3 g per 100 g, including meat and dairy products, edible oils and animal fats, margarines and spreads.
The resultant price rise was “non-trivial”, write the researchers, with a standard 500 g pack of butter - which contains 260 g of saturated fat - rising by 20%, or 0.33€.
Take it with a pinch of salt?
But its results have been slammed by Chris Snowdon, head of lifestyle economics at the Institute of Economic Affairs, who said it is "unlikely" that a measurable improvement in health could result from such a trivial reduction in fat consumption over such a short period of time.
“The most interesting finding in this study is that salt consumption rose as a result of the fat tax. This is the kind of unwelcome and unintended consequence that happens when government tries to micromanage people's diet. A pinch of salt should also be taken with the authors' figures on health outcomes,” he told FoodNavigator, adding that the results are at odds with a previous study which found no impact on health.
Smed said they had not analysed the reason behind the increase in salt intake but this matched the results from earlier simulation studies. When asked how this could be dealt with she said:
"When you tax one particular nutrient or product consumers will substitute towards other nutrient or products. This might lead to side-effects as we saw with the Danish fat tax. Some of them are good, like the increase in vegetable consumption, others are adverse, as the increase in salt intake. To control for these side effects other adverse nutrients (and minerals) as salt and sugar ought to be taxed as well. Good nutrients as fibres ought to be subsidised.
"To efficiently control for all side-effects you should in principle use taxation systems based on e.g. nutrient profiling that rate products according to their overall healthiness [and] consider their content of all nutrients, good as well as bad."
The tax was also criticised for driving Danes to cross the border into Germany where they stocked up on tax-free foods - which would not have appeared in the household scanner data.
'It must be done again!'
The study has prompted calls among campaigners to bring back the tax with certain caveats. Speaking to Videnskab, professor of nutrition and public food at Aalborg University, Bent Egberg Mikkelsen, said: "It must be done again, and this time in the right way and with the right preparation. First, the experts define the general principles for the tax. Next, they sit down with industry organisations and discuss how the tax is implemented in the most manageable way. Finally, it is important that the revenue from the tax not become a cash cow for politicians to avoid creating a political interest in how much tax should be - as we saw in the case of the fat tax."
But any attempts to bring back a fat tax would also have to be squared with EU law: two years after it was repealed, the Commission launched an inquiry, which is ongoing, to determine whether it had constituted illegal state aid for manufacturers whose products were exempt by giving them an unfair financial advantage.
A Commission spokesperson told FoodNavigator at the time it supported any country’s efforts to develop healthy eating choices – even if they involve taxation measures – but these measures must comply with EU law.
The study
Shopping data from over 2500 Danish households was analysed and the nutrition content of the foods calculated using the Danish Food Composition Databank. For the 123 processed products that are not included in the back, nutrient information was obtained from supplier websites.
However salt consumption also increased for all age groups except younger women. “In total, the tax is estimated to produce a small reduction in NCD mortality, almost exclusively in men and younger women. The lack of impact of the tax in older women is because of increases in salt consumption and decreases in fruit and fibre consumption, offsetting the positive effect of reductions in saturated fat.”
"These age and gender differences in substitution effects are likely to originate from differences in current dietary habits and difference in price sensitivities and substitution patterns," they write.
Source: European Journal of Clinical Nutrition
First published online: 13 April 2016, doi:10.1038/ejcn.2016.6
“The effects of the Danish saturated fat tax on food and nutrient intake and modelled health outcomes: an econometric and comparative risk assessment evaluation”
Authors: S. Smed, P. Scarborough, M. Rayner and J.D. Jensen