Fiscal Incentives − Imperative for Promoting Healthy Eating

Sir, Worldwide, consumption of unhealthy foods (low-nutrient-high-calorie) has increased massively because of their easy availability, affordability, and the perfect packaging for mobile intake. Unhealthy foods are one of the major behavioral risk factors for non-communicable diseases and contribute a large proportion of mortality and morbidity. A few years before, we had little to no option of consuming processed high-calorie-packed foods and often had to content ourselves with traditional healthier snacks like peanuts, corn, coconut, chikki, besan, fruits, and fresh juices in the shops available nearby. Perceived misconceptions and marketing have caused a shift in food choices. World Health Organisation's (WHO) nutrition report says 3.7 million deaths could be prevented by 2025 if governments boost their focus on healthier eating.[1] To promote healthy eating, a spectrum of strategies are available: mass education (dietary guidelines, media), point-of-purchase information (front-of-package labeling), price policies (taxation on sweetened beverages), food quality standards, built environment changes (school-based restrictions of unhealthy foods).[2] The most commonly applied strategies like mass education and package labels can be only effective when consumers have knowledge or are more aware or motivated. Product branding blinds the value of the official package labels and consumer attention at the point of purchase. The effectiveness of these policies depends mainly on the consumers' awareness and showed variable results overall and have minimal effects in marginalized groups.[3,4] However, these approaches may have an effect on longer-term health beyond immediate consumer behavior by industry regulations.[3] These approaches can be valuable only as part of a broader, multicomponent government food and nutrition strategy. Data from experimental choice studies found that consumers can be highly responsive to food prices, and the consumption of targeted foods can be easily influenced by taxation and subsidies.[5,6] The most appropriate strategy will be the mix of targeted food tax and subsidy on fruit and vegetables or other core foods. Posing higher taxes on unhealthy food items affects lower socio-economic groups more, as it fetches the chances of fulfilling the stomach at least. For example, in rural areas, most parents provide their children with packed food items, unaware of their constituents and nutrient value. The parents assume that giving them something to eat is better than keeping them hungry. More emphasis should be on subsidies than taxation for healthy eating; this makes nutritious food as affordable as unhealthy packed foods. Taxation and subsidies on unhealthy and healthy foods aimed at consumers, producers, and retailers have more consistent evidence of effectiveness than awareness programs.[7] Taxation on sugar-sweetened beverages is already implemented in various countries, and the same should be followed for all forms of junk food. Revenues generated through unhealthy food taxes can be utilized to incentivize healthy foods.[8] Manipulating prices of different foods in discrete environments, such as schools, supermarkets, and vending machines, has resulted in more purchases of healthier options.[7,9,10] General subsidies may disproportionately benefit high-income consumers rather than low-income groups.[7] To reduce these inequalities, subsidies should be well-targeted through nutrition and food assistance programs. Subsidies in specific spaces like government-operated canteens could enable poorer sections to buy them at heavily subsidized prices. Local stores, the primary locations for food and snack purchases, are considered opportune places to help influence healthy choices. The Government of India implemented various initiatives such as Nutrition Month (Poshan maah), Eat Right India campaigns, and front-of-package labeling; all these interventions focus on ensuring awareness at the population level. The next focus shall be on increasing government allocation for national nutrition programs like the mid-day meal could enable many to avail of free or subsidized standard (nutrient-adequate) breakfasts at school rather than the average tiffin consumed. Tamil Nadu government has already piloted and found this effective in school enrolment and improving nutritional status. Schools can be the primary focal point for implementing fiscal nutrition policies such as the free or low-price provision of fruits and vegetables through food assistance programs. The take-home rations provided as part of supplementary nutrition programs in Anganwadi centers manufactured by Women Self Helps Groups shall be made available in Targeted Public Distribution System (ration shops), schools, and private marketers at a subsidized price using marketing strategies to make it available for everyone. The Make in India campaign is another initiative that can make healthy food processing through government investment or the strategic building of a market through entrepreneurial ventures. Various indigenous brands of India started marketing food items ranging from grains to snacks with healthy and natural labels at a lesser price compared to other private players. Despite several criticisms of unregulated preparation and nutrition labels, these brands expected a 2.5%-fold rise in sales in the next 5 years. It shows the readiness of people to accept healthy foods at a subsidized price with perfect marketing. To conclude, the government should focus on fiscal incentivizing and social marketing of healthy targeted foods to promote healthy eating. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.