Palm Oil Taxes and Cardiovascular Disease Mortality in India: Economic-Epidemiologic Model

Basu, Sanjay , Singer Babiarz, Kimberly, Ebrahim, Shah , Vellakkal, Sukumar , Stuckler, David and Goldhaber-Fiebert, Jeremy, Palm oil taxes and cardiovascular disease mortality in India: economic-epidemiologic model. British Medical Journal 2013; 347

Posted: 6 Mar 2014

See all articles by Sanjay Basu

Sanjay Basu

Stanford University - Center for Primary Care and Outcomes Research and Center for Population Health Sciences; Harvard University - Center for Primary Care

Kimberly Singer Babiarz

Stanford University

Shah Ebrahim

Public Health Foundation of India

Sukumar Vellakkal

Public Health foundation of India (PHFI)

David Stuckler

University of Cambridge - Faculty of Human, Social, and Political Science

Jeremy Goldhaber-Fiebert

Stanford University

Date Written: October 22, 2013

Abstract

Objective: To examine the potential effect of a tax on palm oil on hyperlipidemia and on mortality due to cardiovascular disease in India.

Design Economic-epidemiologic model. Modeling methods: A microsimulation model of mortality due to myocardial infarction and stroke among Indian populations was constructed, incorporating nationally representative data on systolic blood pressure, total cholesterol, tobacco smoking, diabetes, and cardiovascular event history, and stratified by age, sex, and urban/rural residence. Household expenditure data were used to estimate the change in consumption of palm oil following changes in oil price and the potential substitution of alternative oils that might occur after imposition of a tax. A 20% excise tax on palm oil purchases was simulated over the period 2014-23.

Main outcome measures: The model was used to project future mortality due to myocardial infarction and stroke, as well as the potential effect of a tax on food insecurity, accounting for the effect of increased food prices.

Results: A 20% tax on palm oil purchases would be expected to avert approximately 363,000 (95% confidence interval 247,000 to 479,000) deaths from myocardial infarctions and strokes over the period 2014-23 in India (1.3% reduction in cardiovascular deaths) if people do not substitute other oils for reduced palm oil consumption. Given estimates of substitution of palm oil with other oils following a 20% price increase for palm oil, the beneficial effects of increased polyunsaturated fat consumption would be expected to enhance the projected reduction in deaths to as much as 421,000 (256,000 to 586,000). The tax would be expected to benefit men more than women and urban populations more than rural populations, given differential consumption and cardiovascular risk. In a scenario incorporating the effect of taxation on overall food expenditures, the tax may increase food insecurity by <1%, resulting in 16,000 (95% confidence interval 12,000 to 22,000) deaths.

Conclusions: Curtailing palm oil intake through taxation may modestly reduce hyperlipidemia and cardiovascular mortality, but with potential distributional consequences differentially benefiting male and urban populations, as well as affecting food security.

Keywords: tax, cardiovascular disease mortality, India, economic-epidemiologic model

JEL Classification: l12, l18

Suggested Citation

Basu, Sanjay and Singer Babiarz, Kimberly and Ebrahim, Shah and Vellakkal, Sukumar and Stuckler, David and Goldhaber-Fiebert, Jeremy D., Palm Oil Taxes and Cardiovascular Disease Mortality in India: Economic-Epidemiologic Model (October 22, 2013). Basu, Sanjay , Singer Babiarz, Kimberly, Ebrahim, Shah , Vellakkal, Sukumar , Stuckler, David and Goldhaber-Fiebert, Jeremy, Palm oil taxes and cardiovascular disease mortality in India: economic-epidemiologic model. British Medical Journal 2013; 347 . Available at SSRN: https://ssrn.com/abstract=2404859

Sanjay Basu (Contact Author)

Stanford University - Center for Primary Care and Outcomes Research and Center for Population Health Sciences ( email )

1070 Arastradero Road Office 282
Palo Alto, CA 94304
United States

Harvard University - Center for Primary Care ( email )

Cambridge, MA
United States

Kimberly Singer Babiarz

Stanford University ( email )

No Address Available

Shah Ebrahim

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

Sukumar Vellakkal

Public Health foundation of India (PHFI) ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

HOME PAGE: http://www.phfi.org

David Stuckler

University of Cambridge - Faculty of Human, Social, and Political Science ( email )

Cambridge, CB3 9DD
United Kingdom

Jeremy D. Goldhaber-Fiebert

Stanford University ( email )

Stanford, CA 94305
United States

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