Changes to marketing in response to sugary beverage taxation: the Soft Drinks Industry Levy in the United Kingdom
Background: Overall sugar intake in the United Kingdom (UK) continues to exceed recommended levels. As high sugar consumption contributes to multiple non-communicable diseases, the World Health Organization recommends the implementation of sugary beverage taxes (SBT). To this end, the UK government introduced a levy on soft drinks manufacturers in 2018, known as the Soft Drinks Industry Levy (SDIL). SBTs are likely to lead to a variety of reactions among stakeholders across the food sector that may, in turn, impact on beverage, and sugar, consumption. Reactions of soft drinks companies may be particularly important in this regard. It has been hypothesised that soft drinks companies may respond to an SBT with marketing to protect their profits. Many definitions of marketing exist, sharing an understanding that marketing is a multi-component process that encompasses many activities, often coordinated by strategy. There is substantial literature acknowledging that marketing is an important determinant of dietary behaviours and inequalities. Though existing research on SBTs has explored their impacts on some features of marketing (such as changes to price or formulation), many other features have been overlooked (such as promotion). Furthermore, existing evidence has often failed to situate itself within a wider understanding of marketing as reflecting strategic coordination of activities. This risks overlooking the mechanisms through which changes in marketing in response to an SBT may enhances or undermine the SBTs impact on public health. Aims: This dissertation aimed to understand what ‘marketing’ encompasses in the context of SBTs, explore whether marketing changes are likely to influence the outcomes of SBTs, and assess marketing changes that followed the SDIL. Method 1: First, a scoping review of reviews using principles of critical interpretive synthesis was used to find conceptual confusion in the study of food and drink marketing in the public health literature to date. From these results, I concluded that future studies of marketing, including those specific to SBTs, should be grounded in the understanding that a broad range of separate marketing activities take effect in integration. Method 2: Second, I fitted multinomial logistic regression models to the 2017 cross-section of the International Food Policy Study, to explore the association between exposure to one form of marketing – sugary beverage promotion – and sugary beverage consumption. In doing so, I found exposure to promotion was associated with the consumption of sugary beverages. . The results tentatively suggest that changes to this form of sugary beverage marketing following an SBT could influence subsequent consumption behaviours, and thus the outcomes of the SBT. Method 3: Third, thematic analysis of 18 interviews with representatives from academia, civil society and industry, explored how marketing might change following the SDIL. Analyses unearthed the breadth and variety of anticipated changes that marketing might encompass, the decision-making contributing to a companies’ selection of these changes, and factors within and external to a company that might lead to heterogeneous responses across the soft drinks industry. Method 4: Finally, I used interrupted time series analyses to explore changes in leading soft drinks companies’ expenditure on advertising following the announcement and implementation of the SDIL. Analyses used advertising expenditure data supplied by Nielsen, a market research company, that measures expenditure through various media types (though excluding some novel forms of digital media). Though there was no evidence of changes in expenditure, it is possible that promotion changed in other ways, for example through greater use of digital media platforms. Conclusions: Evidence presented in this dissertation adds to existing literature by presenting a more comprehensive study of marketing in the context of SBTs. Together, this evidence illustrates that ‘marketing’ could be an important lens through which the complexity and breadth of soft drinks company responses to an SBT might be understood. Doing so has the potential to inform the design of policy strategies around SBTs that pre-empt adverse responses by soft drinks companies, such as complementary polices that restrict any increases in advertising, and thus may have better health outcomes. Moreover, embedding a greater appreciation of marketing in the design of public health policies might help them elicit commercial responses that amplify favourable health outcomes without harming profit, achieving both public health and commercial goals.