Table 3.

Key Policy Elements and Characteristics of Food Price Policy Design to Improve Cardiometabolic Health.

Policy Elements	SSB tax	“Junk” food tax	Healthy food subsidya
Level of governmentb	federal, state, local, tribal	federal, state, local, tribal	federal, state, local, tribal
Target population	whole population	whole population	whole population, seniors, low-income population (participants of SNAP, WIC, seniors)
Dietary target	SSBs, sweetened beverages, soft drinks, sugary drinks, beverage high in calories and sugar, beverages that contained added sugar	snack food, junk food, minimal-to-no nutritional value foods, non-grocery staples, non-foods	fruit and vegetables, water, “fresh”, “healthy,” “staple” or “unprepared” foodc
Dietary target definition	product + calorie-basedd	product-based definitione nutrient-based definitionf product + nutrient-based definition	product-based definition
Type of taxg	excise tax, sales tax, gross-receipts tax	excise tax, sales tax, gross-receipts tax	n/a
Tax base and tax rateh	price-based: 0.5%−6.5% (sales/gross-receipts) volume-based: 0.5–3 cents/oz (excise) volume-based: 5–25 cents/deposit container (sales/excise) tieredi, volume-based: 1–2 cents/oz (excise) sugar content-based: 1 cent/1 tsp. of sugar (excise)	nutrient based: 0.05 cent/g of sugar price-based: 0.25–5.5% (sales/gross-receipts tax)	n/a
Subsidy scheme and ratej	n/a	n/a	tax exemption (% vary); price discount (% vary); cash-value benefit ($4– 10/month, or $0.25-$1 per dollar spent)
Implementation mechanism	excise tax: levied on manufacturers, distributors, wholesalers and retailers; sales tax: paid by consumers and collected by retailers at the point of sale; gross-receipts tax: levied on the business activity of the seller	excise tax: levied on manufacturers, distributors, wholesalers and retailers; sales tax: paid by consumers and collected by retailers at the point of sale; gross-receipts tax: levied on the business activity of the seller	paper/electronic coupons/vouchers, tokens, checks, discounts at point of purchase, rebate on store-loyalty card or EBT-type card after purchase
Earmarkingk	child obesity prevention, Medicaid, health research, medical school fund	child obesity prevention, healthcare	n/a

^aSubsidies to participants of government food assistance programs (policy strategy #10) are covered here.

^bLevel of government refers to the level of government at which policy cases were identified in the US. The legal authority for federal, state and local government to enact these dietary policy strategies is outside the scope of this review.

^c“Fresh”, “Healthy”, “unprepared” or “staple” foods may include fruits and vegetables, seeds, nuts and nut butters, whole grains, beans and legumes, raw animal products (e.g., eggs, meat, poultry, fish, milk), bread and baking ingredients.

^dSugar-sweetened beverages (SSBs) were typically defined by product category (e.g., soda, sports drinks, energy drinks, fruit drinks, and presweetened tea and coffee) and calorie/sugar content cut points (e.g. ≥2 calories per oz. or ≥5g of added sugar per 12 oz). Artificially sweetened beverages are included in some cases. Milk, milk-based drinks, 100% juice, water, coffee and tea without added sweeteners, dietary supplements, medical beverages, oral electrolyte solutions, and infant formula are typically excluded.

^eTaxed products may include SSBs, candy, chips, pretzels, desserts, frozen desserts, baked goods, cereals/granola bars, processed meat products.

^fNutrient-specific cut-points to target e.g., added sugar, sodium, saturated fats.

^gSales tax is imposed on the retail sale of taxed products; it is an ad valorem tax proportional to the price of the products. An excise tax is typically imposed on the manufacturers or distributor, and it is typically a per unit tax (e.g., volume or weight). Manufacturers or distributors may choose to pass the cost of the excise tax onto consumers, in which case the tax would be reflected on the price tag of the products. Compared to sales tax, an excise tax typically results in a higher price increase of the taxed products and is more visible to consumers compared to sales tax (which is visible only at point-of-purchase). Gross-receipts is a tax on the gross revenue of a business.

^hRate of tax is not specified in some policy cases.

ⁱOne example is the Massachusetts bill S.B.1562, which proposed a tiered tax approach: tier 1: not taxed; tier 2: 1 cent/oz; tier 3: 2 cents/oz. (Tier 1: beverages with less than 5g of added sugar per 12 oz.; Tier 2: beverages with between 5 −20g of added sugar per 12 oz.; Tier 3: beverages with >20g of added sugar per 12 oz.).

^jRate of subsidy is not specified in some policy cases.

^kEarmarking is a budgeting practice that dedicates tax revenue to a specific program or purpose. Earmarking was identified for a variety of purposes, and those related to health were listed here. Earmarking was observed for excise taxes and gross-receipts tax as sales tax revenue is generally deposited into the general treasury.