Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact

McGill, Rory; Anwar, Elspeth; Orton, Lois; Bromley, Helen; Lloyd-Williams, Ffion; O’Flaherty, Martin; Taylor-Robinson, David; Guzman-Castillo, Maria; Gillespie, Duncan; Moreira, Patricia; Allen, Kirk; Hyseni, Lirije; Calder, Nicola; Petticrew, Mark; White, Martin; Whitehead, Margaret; Capewell, Simon

doi:10.1186/s12889-015-1781-7

Table 2 Summary of “Price” interventions

From: Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact

Author	Study	Setting	Intervention	Quality^∆	Outcome measured	SEP measurement	Effect on SEP inequalities^†
Allais [ 34 ]	Modelling study	France	10% Tax on high energy density food:	2	Change in fat consumed (%)	Household income	↓
Cash [ 40 ]	Modelling study	USA	1% Subsidy on fruit and vegetables	2	CHD incidence	Household income	↑*
Dallongeville [ 35 ]	Modelling study	France	5.5% to 2.1% Subsidy on fruit and vegetables	2	Change in mean fruit and vegetable consumption (g/d)	Household income	↔*
Dallongeville [ 35 ]	Modelling study	France	Food stamp program for fruit and vegetables	2	Change in mean fruit and vegetable consumption (g/d)	Household income	↓*
Finkelstein [41]	Modelling study	Canada	20% Tax on high energy density food	2	Mean change in energy intake from all beverages	Household income	↔*
			40% tax on carbonated sugar sweetened beverages				↔*
			20% tax on all sugar sweetened beverages				↔*
			40% tax on all sugar sweetened beverages				↔*
Nederkoorn [ 36 ]	RCT	Holland	50% Tax on high energy density food	5	% change in calories purchased in lean individuals	Food budget	↓*
Nnoaham [ 37 ]	Modelling study	UK	17.5% tax on high energy density foods	2	% change in calorie intake	Household income	↔*
			17.5% tax on food classified as ‘less healthy’ by nutrient profiling				↓*
			Combined the taxation on ‘less healthy’ foods with a 17.5% subsidy on fruit and vegetables				↓*
			As above with a 32.5% subsidy on fruit and vegetables				↓*
Sharma [ 42 ]	Modelling study	Australia	20% tax on sugar sweetened beverages	2	Mean net change in body weight in kg	Household income	↑*
Smed [ 38 ]	Modelling study	Denmark	5% tax on fatty meat and dairy products with subsidies on fruit and vegetables, potatoes and grain products	2	Change in nutrient demand of saturated fat (%)	Social class	↓
			7.89 DKK/kg tax on saturated fats with subsidies on fibre				↓
			7.89 DKK/kg tax on saturated fats with subsidies on fibre with an additional 10.3 DKK/kg tax on sugar				↓
Tiffin [ 39 ]	Modelling study	UK	1% Tax on fatty food for every % saturated fat content with a matching subsidy on fruit and vegetables	2	% change in energy intake	Occupation	↓

^∆Quality of empirical studies were assessed using a validated tool [27]. Studies were scored against six criteria and this number was summed to give an overall quality score (maximum of six). The modelling studies were assessed for quality by two independent experts and their scores were converted into a score out of six to allow comparison.
^†the effect on inequalities is displayed symbolically in the table as: ↓ for an Intervention likely to reduce inequalities: the intervention preferentially improved healthy eating outcomes in people of lower SEP, ↑ for an intervention likely to widen inequalities: the intervention preferentially improved healthy eating outcomes in people of higher SEP, and ↔ for an intervention which had no preferential impact by SEP.
*indicates interventions where statistical significance values were given to the quantitative evidence relevant to our review.

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ISSN: 1471-2458

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