Background
Methods
Study design and interview guide
Interview stances | |
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1. According to your world-view, is obesity a personal problem or is it a problem/phenomenon that is of public interest? 2. In your opinion, who holds the responsibility for dealing (preventing and treating) with this issue? 3. What is your opinion on the issue of using negative incentives (i.e., increased taxation) for changing an individual’s lifestyle? 4. Certain countries have initiatives for taxation of unhealthy beverages and food. For example, in May 2010 in Washington DC, a 6% sales tax intended for funding of a physical activity program was imposed on sweetened beverages and energy drinks. What is your opinion about a similar initiative in Israel? (Would you be for it or would you oppose it and why, in terms of the organization that you represent). 5. In your opinion what would be the reaction of the public to such an initiative? (Please specify the reasons for your support or opposition). 6. Do you think that imposing such a tax would affect the public’s consumption of these products? 7. In your opinion, which sectors (apart from the general public) would be expected to oppose such tax? 8. What would be the reasons for opposing such tax? 9. What additional obstacles to implementation of this tax would be expected in Israel? 10. Who, in your opinion would support such a tax? 11. What is your opinion on such a tax if its revenues would be earmarked to specific causes (as compared to a general tax whose revenues are directed to the general treasury)? 12. To which causes should the tax’s revenues be directed? |
Data collection
Participants
Sector | Stakeholders | Number | Gender (n) | Average seniority (years) |
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Health professions | • Health professionals • Representatives of professional associations in the fields of nutrition, healthcare and health promotion | 9 | Females: 6 Males: 3 | 11 |
Legislators | • Members of the Israeli parliament from various political parties | 6 | Females: 1 Males: 5 | 7 |
Policy makers | • Council members of municipal authorities • Israeli government bureaucrats | 4 | Females: 1 Males: 3 | 7 |
Regulators | • Senior officers from the Ministry of Health, the Ministry of Finance and the Israel Tax Authority | 4 | Females: 1 Males: 3 | 14 |
Food and beverage industry | • Senior managers of snack and beverage manufacturers • Managers of national supermarket chains • Catering Managers | 5 | Males: 5 | 12 |
Public representatives | • Leaders of consumer-advocate groups • Social activists | 3 | Females: 1 Males: 2 | 18 |
Media and publishing | • Health and health economy journalists • Representatives of advertising agencies engaged in marketing of snacks and beverages | 4 | Females: 1 Males: 3 | 10 |
Economists | • Health economists | 4 | Males: 4 | 18 |
Total | 39 | Females: 11 Males: 28 | 11 |
Data analysis
Results
Category | Themes |
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The responsibilities of individual and society for obesity, its causes and treatment | • Obesity is a public and private problem • Obesity is a financial (economic) problem |
Negative positions about taxation of sugar sweetened beverages and unhealthy snacks | • Taxation will negatively affect the population because sweet drinks and sweets give people pleasure • The industry lobbyists, the Ministry of Finance and Parliament members will oppose. |
Potential supporters of taxation | • The Government, the Ministry of Finance • Parliament members • The Ministry of Education, education organizations • Parents • Health maintenance organizations, the Ministry of Health, health promoting organizations, health professionals (physicians, nutritionists). • Environmental organizations |
Reference to low socioeconomic populations | • Taxing cause inequality because it affects the poor much more than the rich. |
Alternative strategies to fight obesity | • Regulation and responsibility of the industry • Build a healthier environment • More physical activity • Personal education and responsibility |
Tax rate and its effect on consumption | • Low taxation does not make any consumers change • High taxation is not proportionate |
Public response to the taxation | • The public will oppose, they will never support additional taxation (it is not a popular move) • The public will be indifferent |
Barriers and obstacles to implementing the tax | • Difficulties in defining healthy and unhealthy products • Difficulties in deciding which products to tax. • Higher prices of healthy food • Difficulties in passing the message to the public • Technical and logistic problems with taxation • Enforcement difficulties • Damage to the Industry and danger of worker termination |
Tax complementary activities | • Taxing needs a supporting educational and public promotion and advocacy to follow |
The need for earmarking tax revenue and obstacles to implementation | • The tax revenue will not be used for the tax cause. • Government authorities will oppose. • Learning from the past- the attempt to use the tobacco tax revenue for health cause was a failure. • Opinions against the use of the tax revenue for a specific cause. • The public will support the use of tax revenue for health cause, and there will be less objections to the tax. • Options for the revenue use: health promotion, health education, subsidies for healthy foods. |
Responsibility for obesity and its prevention
“Obesity is a disease; it is defined today as a disease. And it is more than a private problem of the individual; it’s a typical phenomenon of a consumer society”. (Legislator 13).
“I think it’s both. There is the individual responsibility that he cannot ignore. And there is the societal responsibility”. (Media 37).
“It has a long-term effect on the budget… not everybody understands the concept that obesity has long-term social and economic effects, it is a burden on the healthcare system”. (Legislator 16).
“Obesity is a public concern- it’s a burden on the national budget”. (Industry 28).
Views on taxation
Prevention of obesity by taxation of SSBs and unhealthy snacks
“Yes definitely, tax is a very important tool for changing behavioral patterns. I am definitely pro taxation”. (Economists 33).
“It won’t work, if you ask me it won’t work”. (Food and beverages industry 27).
“I don’t think it will work. No, it won’t work, here it won’t work”. (Public Representatives 9).
“I think that if it will cost more they [the parents] won’t have a choice and they won’t buy it. They will argue with their children and they won’t buy it” (Health professions 21).
“I think that manufacturers of soda and chocolate and those kinds of food will object because its will decrease their income”. (Legislator 14).
Positions against taxation
“There should be a limit to government intervention, even if the cause is just and for good values. I think there should be limits to what the government is allowed to intervene in.” (Legislators 16).
“We also eat for our soul”. (Regulators 3).
“People today like to drink sweet drinks, like to eat candy; it helps them relieve their stress”. (Health professions 19).
“In the last few years there is a big increase in overall taxes so it won’t be received as a positive move”. (Media 37).
“The taxes are very high and I don’t want them to be higher, not even for important causes” (Legislators 16).
“The food expenses in the lower socio economic populations take a larger percentage of their budget so it would negatively affect them more”. (Health professions 24).
“It reduces the amount of money available to lower income families to spend on necessary items”. (Legislators 14).
“The problem is more serious in the poorer populations”. (Public Representatives 9).
“Raising the prices would hurt the ones who don’t have money”. (Public Representatives 10).
“It will influence the weaker crowds, [the ones] it can influence”. (Media 38).
“Usually, lower socio-economic populations consume less healthy food products”. (Economists 33).
“The ultra-orthodox always buy these drinks on the weekends”. (Regulators 8).
“The Ethiopians adopted Coca Cola because it is similar to their traditional drink”. (Regulators 3).
Barriers and challenges to implementation of taxation
“The challenge is to deal with the public, how to create a program that won’t cause objections”. (Media 37).
“I think that the biggest challenge would be how to convey this message to the public, as something for their own benefit.” (Health Professions 20).
“The first problem is enforcement which is always a problem in Israel for some reason”. (Health Professions 18).
“The question is how you collect this kind of tax; it requires more bureaucracy and more mess”. (Food and beverages industry 27).
“The definition of healthy is controversial, healthy is not just what is in the food, it is also a matter of quantities. There are unhealthy foods but there are some which are in-between”. (Health Professions 23).
Possibilities of development of a “black market” and attempts to avoid the tax were mentioned
“The tax will increase the price and if there is a demand for the product what’s going to happen is the development of a black market or another thing that can happen is that people would deceive the tax authorities by selling the taxed products without the tax”. (Regulators 5).
“The strongest objection would be the one mounted by manufactures. They won’t hesitate to use the argument of closing factories and firing employees”. (Public Representatives 9).
“The first and most problematic obstacle is the one I mentioned, that even with the taxation, these products are going to be less expensive than the healthy products which are too expensive”. (Media 37).
Complementary and alternative strategies to taxation
“I am siding with the tax. But I think that by itself it won’t be enough, the prevention proportions would be low”. (Health Professions 20).
“It can’t be a “one time” and only one measure. It must come with complementary measures such as a public-relations campaign and education”. (Economists 33).
“The only thing that will work is education; to deal with it [the obesity problem] it’s just education. And it should start from kindergarten”. (Food and beverages industry 27).
“First of all and the most important solution is education and there I would invest first, before all other things”. (Media 38).
“The ministry of finance is against using any tax revenue for specific purposes; they will put tax on snacks and use the money to appoint 30 new ministers.” (Regulators 6).
“We know that the Ministry of Finance does not like the use of tax money for a specific cause. The Ministry of Finance wants every penny they collect to be free for use towards the purposes that they choose”. (Legislators 14).
“We don’t live in an ideal world; the revenue from the tax on cigarettes doesn’t go to the ministry of health”. (Regulators 8).
“I am strongly against funding moves with more taxes”. (Legislators 16).
“Definitely, the tax revenue must be dedicated to this issue”. (Media 36).
“I think it would be more effective and the public would accept it better”. (Economists 33).
“If the government says we took 100 million NIS here and subsidized 100 million in diet food, it seems fair to me”. (Food and beverages industry 27).
“It should not just provide a negative incentive to buying the unhealthy foods, it also gives a positive incentive to buy the healthy ones”. (Policy makers 1).
“If you take this money for a specific purpose it must be fighting obesity”. (Legislators 16).
“I would use it for parks, walking and biking trails”. (Regulators 3).
“I think the money needs to go to education”. (Health Professions 26).
Public response to taxation
“I don’t think the public would stand up and shout”. (Health Professions 26).
“Most [of the public] would oppose”. (Media 38).