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BackgroundTaxes on discretionary foods and sugar-sweetened beverages have emerged as a strategy for health promotion. Between 2018-2019, the Bermuda government introduced a phased sugar tax on imported sugar-sweetened beverages, confectionery, products containing cocoa and pure sugar. The aim of this study was to conduct a qualitative evaluation of perceptions of the tax among the general population and key stakeholders.MethodsWe conducted a survey of the general population (N = 400), and semi-structured interviews with key informants (N = 14) from the government, food and beverage, and health sectors to understand awareness, acceptability, and perceived impact of the tax after implementation. Summary statistics and thematic analysis were conducted for the general population survey data, and thematic analysis using the framework method was conducted for key informant interviews.ResultsGeneral population respondents had high awareness of the sugar tax (94%) but lower awareness of the healthy food subsidy (32%). Most respondents (67%) felt the tax was not an appropriate way to motivate healthier consumption behaviour largely due to perceptions the tax would not be effective (44%), and due to the high price of healthy food (20%). However, nearly half (48%) of respondents reported consuming fewer taxed products, primarily for health reasons but also motivated by price increases. Key informants indicated there was high awareness, but limited understanding of the tax policy. Most informants expressed support for taxation as a health promotion strategy, conditional on policy implementation. The tax was not believed to have had an impact on consumption. Factors include the lack of clear price differentiation and the absence of accompanying health education or health promotion. No informants were aware of use of tax revenues for health purposes and tax revenue was reportedly re-directed after implementation.ConclusionsThere was high awareness, but limited acceptability of the tax as implemented. Clarity in the tax policy, appropriateness of the tax mechanism, and use of revenue in alignment with the tax aim are critical components for acceptance. The absence of complementary education and health promotion further affected acceptance and may limit potential health impacts. The lessons learned in Bermuda can inform similar policies in other settings. |
