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Abstract

Background
While food taxes are proposed to promote healthier dietary choices and mitigate diet-related diseases, addressing rising UK obesity requires navigating a highly complex web of causal mechanisms. Economic evaluations of these interventions often lack a documented understanding of this systemic complexity. To bridge this gap, this study aims to comprehensively map the system by identifying the specific components affected, the causal pathways (mechanisms), and the individual and system-level factors (context) influencing the ultimate impact of food taxes.

Methods
A diagrammatic representation of the conceptual model was developed through an iterative process. We first undertook a synthesis of reviews of food taxes and a rapid review of economic evaluations of food and drink taxes. The research team synthesised these results to describe mechanisms and outcomes for inclusion in the conceptual model. Secondly, the conceptual model was validated and revised according to feedback from 14 stakeholders across academia, policy, and third sector organisations.

Results
Our final conceptual model illustrates system components which were grouped into eight sub-systems including policy infrastructure, industry behaviour, consumer behaviour, household expenditure, nutrition outcomes, health outcomes, environmental outcomes, and macroeconomic outcomes. Food taxes will influence consumption through price changes impacting purchases of taxed food and other purchases resulting in changes to consumption. Industry may modify the effects by absorbing the tax burden, marketing and product development and reformulation. We identify health, macroeconomic and environmental outcomes linked to food, and explore complex feedback loops linking health and macroeconomic performance to household finances further modifying food purchasing. We identify individual and contextual factors that modify these mechanisms.

Conclusions
When studying the impacts of food and drinks taxes, researchers should consider the mechanisms by which individuals and industry can modify the effects of food taxes, and the extent to which these actions can be anticipated. System-wide factors can be documented so that the modelled evidence can be interpreted considering these factors even if they are not explicitly modelled. The conceptual model v3.0 remains dynamic and can be updated as evidence and perspectives on the food tax policy system develop over time.

Publication Type:	Article
Additional Information:	This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher Keywords:	Fiscal policy, Public health, Simulation, Complex systems, Economic, Nutrition
Subjects:	G Geography. Anthropology. Recreation > GE Environmental Sciences H Social Sciences > HB Economic Theory R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Population Health & Policy
SWORD Depositor:	Symplectic Administrator

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