1. Mexico’s sugary drinks tax – behind the scenes
Dr Juan A. Rivera
Instituto Nacional de Salud Publica
Mexico

2. Content Synopsis of process that led to the tax approval
Generation and use of scientific evidence by the National Public Health Institute to justify and design the tax
Evaluation of the effects of the tax on price, sales volume and other outcomes, and use of the evaluation results to maintain the tax
Lessons learnt that can be applied by cancer societies in their advocacy and lobbying work

3. Synopsis of process that led to the approval of the tax
Public debate about Obesity, food environment and high intake of SSB´s
Incoming Administration and Congress
SCIENCE
Lobbying Organizations
Advocacy Organizations
El Poder del Consumidor
Polithink
Food and Beverage Industry: a Strong force against the tax
Need of Government Revenue
INSP
Science (Research Institution)
Legislative and
Executive Branches of Government
PROCESS IN SENATE 2013
A Champion proposed $2 pesos/L tax
Executive proposed a $1 peso/L tax
Senate approved the $1 peso proposal
Resolution on use of tax revenues
Industry attempted to reverse the tax in 2015 but failed
Proposal to increate tax to $2/L in 2016 also failed
SSB´s tax approved

4. Evidence about Nutrition transition in Mexico

5. Prevalence of overweight and obesity
Prevalence of overweight and obesity * in children 5-11 y, adolescent girls and women (1988 to 2012) %
69.3
70.8
61.0
32.3
32.0
33.4
35.8
34.5
28.3
25.5
11.1
Children 5-11 y
Adolescent girls
(12-19 y)
Women
(20-49 y)

6. The need of a comprehensive multicomponent strategy for obesity prevention
POLICY AREA
SPECIFIC POLICY ACTIONS IN MEXICO N
Nutrition label standards and regulations on the use of claims and implied claims on foods
GUIDELINE DAILY AMOUNTS (GDA´S) SYSTEM O
Offer healthy foods and set standards in public institutions and other specific settings
FOOD AND BEVERAGE REGULATIONS IN SCHOOLS U
Use economic tools to address food affordability and purchase incentives
TAXES ON SSB´S AND JUNK FOOD  R
Restrict food advertising and other forms of commercial promotion
REGULATION OF MARKETING TO CHILDREN IN TV AND MOVIE THEATERS DURING SELECTED SCHEDULES & PROGRAMS I
Improve the nutritional quality of the whole food supply
NO NATIONAL POLICY S
Set incentives and rules to create a healthy retail and food service environment
ISOLATED EFFORTS (NUTRITION EDUCATION IN GOVERNMENT OWNED RURAL RETAIL STORES) H
Harness the food supply chain and actions across sectors to ensure coherence with health
NO NATIONAL POLICY 
Inform people about food and nutrition through public awareness
CAMPAIGN PROMOTING GENERAL BEHAVIORS: MINDFUL EATING, MOVING AND ATTENDING PRIMARY HEALTH CLINICS
Nutrition advice and counselling in health care settings
DIETARY GUIDELINES RELEASED LAST YEAR IN THE PROCESS OF IMPLEMENTATION IN PHC  G
Give nutrition education and skills

7. HIGH INTAKE OF SUGAR SWEETENED BEVERAGES

8. High Intake of added sugars and sugar-sweetened beverages in Mexico
WHO recommends reducing the intake of free sugars to less than 10% of total energy intake
Added sugars contribute 12.5% total energy intake in Mexican diet (60 gr/person/day)
Sugar-sweetened beverages (SSBs) contribute 70.3% of added sugars
% of Mexicans consuming >10% of total energy from added sugars
Age
Males
Females
1-4 y
60.2%
5-11 y
57.8%
65.9%
12-19 y
70.8%
84.6%
≥ 20 y
63.8%
64.1%
Non-dairy SSBs consumed by:
12% of infants <6 mo
36% of infants 6-11 mo
65% of child mo
Sánchez-Pimienta TG. J Nutr 2016;146(Suppl):1888S–96S.
López Olmedo N, y Col. J Nutr 2016;146(Suppl):1856S–65S.
Rodríguez-Ramírez S. y Col. J Nutr 2016;146(Suppl):1916S–23S

9. Evidence about health effects of SSB and added sugars
Meta-analysis by Te Montenga, Mallard S, Mann J (BMJ, 2013)

10. Health Effects of SSB´s and Added Sugars

11. National Recommendations of the use of taxes to fight obesity in Mexico
Beverage recommendations for Mexico (2008)
2007
Evaluate the use of policy instruments such as…taxes … to reduce the consumption of less healthful foods and beverages
2008
One of the policy recommendations was to consider taxing soda
Initiated a public debate about the effects of SSB on health which eventually led to banning SSB in schools and the SSB tax
2012
- Consider Taxing unhealthy processed food (SSB and Junk Food) - Need own and cross price elasticities estimates
- Use of tax revenue for obesity prevention

12. International Recommendations
WHO recommends reducing the intake of free sugars to less than 10% of total energy intake and a further reduction of the intake of free sugars to below 5% of total energy intake
Public policies can influence prices through taxation, subsidies or direct pricing in ways that encourage healthy eating and lifelong physical activity
Use economic tools to address food affordability and purchase incentives

13. Price elasticity demand for soft drinks
Data Sources
By raising a 10% price of the soft drinks, the consumption reduced by:
National Income and Expenditure Surveys (2006, 2008, 2010)
SSB
-11.6%*
Mexican Family Life Survey (2002, 2005)
Soft drink 600ml
-12.9%*
* p<0.01
Elastic Demand
Elasticity larger for the poorest population
Cross-price elasticity results indicate healthy substitutes (water)
Colchero MA, Salgado JC, Unar M. , Hernández M., Rivera JA. Price elasticity of the demand for soft drinks in Mexico. Economics and Human Biology ttp://dx.doi.org/ /j.ehb

14. Mathematical modeling
Mathematical modeling* for projections of effect of soda tax on body weight and diabetes prevented cases
Prev. cases
2030
(X 1000)
2050
10% Tax
977 – 1,420
20% Tax
800 – 1,275
1,960 – 2,870
30% Tax
1,200 – 1,920
2,955 – 4,350
71.3
70.9
70.5
70.1
*Hall KD model (with microsimulation to allow projections for each individual)
Barrientos Gutiérrez T, Meza Rodríguez R, Rodriguez ER, Zepeda Tello R

15. Evaluation of the tax: changes in purchases after the implementation of the tax
A 6 percent average decline in purchases of taxed beverages over 2014 compared to pre-tax trends.
Difference accelerated over 2014 and reached 12% by December 2014.
A 4 percent increase in purchases of untaxed beverages over 2014
Colchero MA, Popkin BM, Rivera JA, Ng SW.. BMJ 2016;352:h6704

16. All socioeconomic groups reduced purchases of taxed beverages.
Evaluation of the tax: changes in purchases after the implementation of the tax
LOW SOCIOECONOMICSTATUS
All socioeconomic groups reduced purchases of taxed beverages.
Reductions higher among lower socio-economic households, averaging 9% decline over 2014 compared to pre-tax trends
MIDDLE SOCIOECONOMICSTATUS
HIGH SOCIOECONOMICSTATUS

17. Essential data for advocacy and action
High and growing prevalences of overweight and obesity and co-morbidities
SSB´s intake is a risk factor for obesity and chronic diseases
Dietary intake of SSB´s in all ages well above WHO upper limit
Own and Cross Price Elasticity of Demand for SSB´s
Fiscal Revenues for different tax designs
Modeling effects of a SSB Tax on obesity and health outcomes
Potential use of revenues for obesity prevention
Taxing SSB´s part of a comprehensive obesity prevention strategy
Evaluation of effects on prices and purchases

18. Conclusions Factors which were instrumental for success of the tax:
Monitoring and research by INSP was key in justifying the need for a SSB tax as part of a comprehensive strategy for obesity prevention in Mexico
The Nutrition Transition information and its dissemination set the stage for the need of policy actions for obesity prevention
Information about the high intake of SSB´s and their harm to health justified actions targeted to discourage their intake
The elasticity studies as well as modeling their potential health impact justified SSB´s taxes

19. Conclusions Factors which were instrumental for success of the tax:
Local as well as international recommendations about the need to limit added sugar and SSB´s intake and to use fiscal policies
Evaluation of the changes in prices and purchases after the tax documented that the tax is working and was key for defending the tax against industry´s attempts to reverse
Generation of evidence by INSP and strategic partnership were vital for tax approval and defense