Abstract
Rising consumption of ultra-processed foods (UPFs) represents a significant public health challenge, disproportionately affecting lower-income populations who face both higher exposure to these products and greater vulnerability to diet-related diseases. This dissertation synthesises current evidence on policy interventions designed to reduce UPF consumption whilst simultaneously addressing socioeconomic inequalities in dietary health. Through systematic literature review, the analysis evaluates fiscal measures, regulatory approaches, and food environment interventions across multiple national contexts. Findings indicate that standalone taxation of UPFs, whilst effective in reducing consumption, produces regressive financial impacts that burden lower-income households. However, combined policy packages pairing UPF taxes with subsidies on minimally processed foods demonstrate superior equity outcomes, generating comparable or larger health benefits for disadvantaged groups whilst minimising welfare losses. Complementary measures including front-of-pack warning labels, marketing restrictions, and school food policies further strengthen these effects, particularly when targeted toward underserved communities. The evidence strongly supports integrated, multi-component policy frameworks that address both demand-side behaviours and supply-side food system structures to achieve meaningful dietary improvements without exacerbating existing health inequalities.
Introduction
The global food system has undergone profound transformation over recent decades, characterised by the increasing dominance of ultra-processed foods in human diets. As defined by the NOVA classification system, UPFs are industrial formulations made predominantly from substances derived from foods and additives, with little if any intact whole food content (Monteiro et al., 2019). These products now constitute the majority of energy intake in many high-income countries, with consumption rising rapidly in low- and middle-income nations (Monteiro et al., 2018).
Accumulating epidemiological evidence links high UPF consumption to adverse health outcomes including obesity, type 2 diabetes, cardiovascular disease, and certain cancers (Srour et al., 2020; Lane et al., 2021). The public health burden associated with these diet-related conditions is substantial, accounting for significant proportions of healthcare expenditure and premature mortality across both developed and developing economies.
Critically, the health impacts of UPF consumption are not evenly distributed across populations. Lower-income groups typically exhibit higher UPF consumption rates, driven by factors including the relative affordability of these products, their widespread availability in food retail environments, aggressive marketing practices, and time constraints affecting food preparation (Machado et al., 2019). This socioeconomic gradient in UPF exposure compounds existing health inequalities, as disadvantaged populations already bear disproportionate burdens of chronic disease.
Policy responses to the UPF challenge have gained momentum internationally, yet significant debate persists regarding which interventions effectively reduce consumption without imposing additional burdens on already vulnerable populations. Traditional fiscal approaches such as taxation may inadvertently worsen inequalities if implemented without complementary measures to support healthy food access. Conversely, information-based interventions like labelling may primarily benefit more educated consumers, potentially widening rather than narrowing dietary health gaps.
This dissertation addresses these tensions by examining the evidence base for UPF-focused policies through an explicit equity lens. Understanding how different policy levers affect various socioeconomic groups is essential for designing interventions that improve population health whilst advancing rather than undermining social justice objectives. The analysis contributes to ongoing academic and policy debates regarding the appropriate balance between individual behaviour change approaches and structural food system transformation.
Aim and objectives
Aim
To critically evaluate policy interventions for reducing ultra-processed food consumption with explicit attention to their differential impacts across socioeconomic groups, identifying approaches that achieve dietary improvements without exacerbating existing inequalities.
Objectives
1. To examine the evidence for fiscal interventions, specifically taxes on ultra-processed foods and subsidies on minimally processed alternatives, assessing their effectiveness and distributional consequences across income groups.
2. To evaluate regulatory and information-based measures including front-of-pack labelling and marketing restrictions, with particular attention to differential uptake and impact by socioeconomic status and education level.
3. To analyse school food policies and food environment interventions as mechanisms for reaching vulnerable populations and children in disadvantaged communities.
4. To synthesise evidence on combined policy packages that pair demand-side measures with supply-side food system interventions, assessing their potential for achieving equity-positive health outcomes.
5. To develop evidence-based recommendations for policymakers seeking to reduce UPF consumption whilst protecting and supporting lower-income households.
Methodology
This dissertation employs a structured literature synthesis approach to examine policy options for reducing ultra-processed food consumption with attention to equity implications. Literature synthesis represents an established methodology for integrating evidence across multiple studies to address complex policy questions where experimental evidence may be limited or context-dependent (Snyder, 2019).
Search strategy and source identification
The primary evidence base derives from peer-reviewed literature published in major academic journals, supplemented by policy documents from governmental bodies and international health organisations. Sources were identified through systematic database searching and citation tracking, with particular attention to recent modelling studies, natural experiments, and policy evaluations from diverse national contexts including Brazil, Mexico, Chile, and the United States.
Inclusion criteria prioritised studies examining fiscal measures (taxes and subsidies), regulatory interventions (labelling, marketing restrictions), school food policies, and food environment interventions, with explicit reporting of outcomes by socioeconomic indicators. Studies lacking differentiated analysis by income, education, or other equity-relevant variables were included for contextual purposes but weighted less heavily in synthesised conclusions.
Analytical framework
The synthesis applies an equity-focused analytical framework examining each policy lever across multiple dimensions: effectiveness in reducing UPF consumption or improving diet quality; distributional impacts across income groups; potential for regressive financial burden; and complementarity with other interventions. This approach enables systematic comparison of policy options whilst maintaining explicit attention to inequality implications.
Evidence quality was assessed according to study design, sample size, control for confounding variables, and replicability of findings across contexts. Economic modelling studies were evaluated for transparency of assumptions and sensitivity analyses. Policy evaluations from natural experiments were considered particularly valuable given the ethical and practical constraints on randomised controlled trials of population-level food policies.
Limitations
Several limitations merit acknowledgement. Literature synthesis necessarily depends upon the quality and scope of underlying primary research, which varies considerably across policy types and geographic contexts. Most robust evidence derives from middle-income Latin American countries and the United States, potentially limiting generalisability to other settings. Additionally, time lags between policy implementation and research publication mean that recently adopted interventions may be underrepresented in the evidence base.
Literature review
Ultra-processed foods and health inequalities
The relationship between ultra-processed food consumption and health outcomes has received extensive research attention over the past decade. Prospective cohort studies consistently demonstrate associations between higher UPF intake and increased risk of obesity, metabolic syndrome, cardiovascular disease, and all-cause mortality, with dose-response relationships evident across multiple populations (Srour et al., 2020; Lane et al., 2021).
Importantly, UPF consumption exhibits strong socioeconomic gradients in most studied populations. Lower-income households allocate greater proportions of their food expenditure to ultra-processed products, reflecting both their relative affordability compared to fresh foods and their widespread availability in food retail environments serving disadvantaged communities (Machado et al., 2019). Time poverty among lower-income workers further drives reliance on convenient, ready-to-eat UPF products requiring minimal preparation.
These consumption patterns translate into socioeconomic inequalities in diet-related disease burden. Individuals from disadvantaged backgrounds experience higher rates of obesity, diabetes, and cardiovascular conditions, with dietary factors representing a major contributing pathway. Policy interventions that fail to account for these dynamics risk exacerbating rather than ameliorating health inequalities.
Fiscal interventions: taxes and subsidies
Taxation represents the most extensively studied fiscal approach to reducing consumption of unhealthy foods and beverages. Sugar-sweetened beverage taxes implemented in multiple jurisdictions have demonstrated meaningful reductions in purchases, though evidence on longer-term health impacts remains limited (Teng et al., 2019). Extending this approach to broader categories of ultra-processed foods has attracted increasing policy interest.
Modelling research from Brazil examining equity impacts of UPF taxation found that a 20% tax on ultra-processed products improves diet quality across income groups (Pereda et al., 2024). However, the study identified important equity considerations: whilst health benefits accrued similarly across socioeconomic strata, the financial burden of taxation fell disproportionately on lower-income households as a proportion of their food budgets.
Similar findings emerged from economic modelling in the United States context. Research by Valizadeh and Ng (2024) examined combined fiscal policies comprising a 20% tax on ultra-processed foods paired with approximately 20% subsidies on fruits, vegetables, and minimally processed foods. This combined approach generated improved diet quality across the population, with lower-income households exhibiting similar or larger relative health gains compared to higher-income groups. Critically, the inclusion of subsidies on healthy foods protected lower-income budgets from welfare losses that would otherwise result from standalone taxation.
The Brazilian evidence specifically identified fruit and vegetable subsidies as the most equity-enhancing policy option for lower-income households (Pereda et al., 2024). By directly reducing the cost of healthy alternatives, subsidies address the affordability barriers that drive differential UPF consumption across income groups. Combined tax-subsidy packages thus demonstrate potential to achieve both health improvement and equity protection objectives simultaneously.
Evidence from the United States further indicates that lower-income households reduce taxed calories more substantially than higher-income groups in response to UPF taxation, potentially narrowing rather than widening nutritional gaps between socioeconomic strata (Valizadeh and Ng, 2024). This finding suggests that price sensitivity among lower-income consumers can be leveraged positively when taxation is accompanied by subsidised alternatives.
Labelling and information-based interventions
Front-of-pack warning labels represent a prominent regulatory approach to informing consumer choice regarding ultra-processed and nutritionally poor foods. Chile’s implementation of mandatory warning labels for products high in energy, sugar, sodium, or saturated fat has generated substantial research interest as a natural experiment in population-level dietary intervention.
Evidence indicates that front-of-pack warning labels reduce UPF purchasing, with effects operating through both consumer choice mechanisms and product reformulation by manufacturers seeking to avoid warning symbol requirements (Taillie et al., 2020). However, research examining differential impacts by socioeconomic status reveals important equity considerations.
Studies from Mexico and Chile demonstrate that warning labels exhibit stronger effects among more educated consumers, potentially reflecting greater health literacy and capacity to interpret nutritional information (Popkin et al., 2021; Langellier et al., 2021). The equity implications of this differential effectiveness depend critically upon baseline consumption patterns: if higher-educated groups currently consume more UPFs, labelling may reduce population-level inequalities by disproportionately affecting their consumption. Conversely, if UPF consumption is concentrated among lower-educated groups who respond less strongly to labels, differential effectiveness could widen existing dietary gaps.
Agent-based modelling research examining potential impacts of labelling policies in Mexico found that effects vary substantially across stages of the nutrition transition, with equity implications depending on the current social distribution of UPF consumption (Langellier et al., 2021). This finding underscores the importance of contextual analysis when designing and evaluating labelling interventions.
Marketing restrictions represent a complementary regulatory approach with particular relevance for protecting vulnerable populations. Children experience intensive exposure to UPF marketing through multiple channels including television, digital media, and point-of-sale environments. Evidence indicates that marketing influences food preferences, consumption patterns, and purchasing requests among children, with exposure higher among children from disadvantaged backgrounds (Cairns et al., 2013).
Restrictions on marketing of unhealthy foods to children, whilst challenging to implement comprehensively in digital environments, demonstrate potential for reducing consumption pressures among young people (World Health Organization, 2010). The equity case for such restrictions rests on protecting populations with limited capacity for critical evaluation of commercial messaging.
School food policies
School food policies that ban or restrict ultra-processed products whilst prioritising minimally processed alternatives directly improve children’s food environments during significant portions of their daily food exposure. Given that children from disadvantaged backgrounds may have limited access to healthy foods outside school settings, such policies hold particular promise for reducing dietary inequalities.
Research examining school food interventions demonstrates that standards restricting availability of UPFs and sugar-sweetened beverages can improve dietary intake among students, with effects potentially more pronounced among children from lower-income families who rely more heavily on school-provided meals (De Saraiva Moura and De Carvalho, 2025; Pomeranz, Mande and Mozaffarian, 2023).
Targeting school food improvements to disadvantaged areas further enhances equity potential. Universal free school meal programmes combined with nutritional standards ensuring minimally processed food provision address both financial and availability barriers to healthy eating among children facing household food insecurity. Evidence from such programmes indicates improvements in dietary quality and educational outcomes among beneficiary students (Popkin et al., 2021).
Food environment and supply-side interventions
Critical analysis of existing UPF policy responses reveals a predominant focus on individual behaviour change mechanisms, with substantially less attention to structural transformation of food production and retail systems. Reviews of regulatory approaches highlight this imbalance, arguing that demand-side interventions alone are insufficient to address the fundamental drivers of high UPF consumption embedded in contemporary food systems (Northcott et al., 2025; Baker et al., 2025).
More transformative approaches would shift production incentives, retail environments, and pricing structures toward minimally processed foods, particularly in underserved communities where healthy food access is most constrained. Supply-side interventions addressing these structural factors complement demand-side measures by ensuring that consumers have meaningful access to the healthy alternatives they are encouraged to choose (Touvier et al., 2023).
Incentives for small retailers in low-resource areas to stock healthy foods represent one equity-oriented supply-side lever receiving policy attention (Pomeranz, Mande and Mozaffarian, 2023). Such programmes address food desert dynamics in which residents of disadvantaged neighbourhoods face limited geographic access to retailers offering affordable minimally processed foods. By improving the retail food environment, these interventions enable demand-side policies to achieve their intended effects among populations who would otherwise lack practical alternatives to UPF consumption.
Broader food system transformation addressing agricultural subsidies, food manufacturing practices, and retail concentration also merits consideration in comprehensive UPF policy frameworks. However, such structural interventions face substantial political economy challenges given the commercial interests vested in existing food system arrangements (Baker et al., 2025).
Discussion
The synthesised evidence supports several key conclusions regarding policy approaches to reducing ultra-processed food consumption whilst protecting against inequality exacerbation. These findings carry significant implications for public health policymaking across diverse national contexts.
The case for combined fiscal packages
Perhaps the most robust finding emerging from the evidence synthesis concerns the superiority of combined tax-subsidy approaches over standalone taxation. Whilst UPF taxes alone demonstrate effectiveness in reducing consumption, their regressive financial burden represents a significant equity concern that undermines social justice objectives. The inclusion of subsidies on minimally processed foods transforms the equity profile of fiscal intervention, protecting lower-income budgets whilst maintaining consumption reduction incentives.
The Brazilian modelling evidence specifically identifies fruit and vegetable subsidies as the most equity-enhancing policy option for disadvantaged households (Pereda et al., 2024). This finding aligns with economic theory regarding the importance of affordable substitutes when taxation is employed to discourage consumption of particular goods. Without accessible alternatives, taxation simply extracts financial resources from consumers whilst limiting capacity for behavioural change.
The United States evidence further demonstrates that lower-income households can exhibit greater responsiveness to combined fiscal policies than higher-income groups, actually narrowing rather than widening nutritional inequalities (Valizadeh and Ng, 2024). This finding challenges assumptions that fiscal approaches inherently harm disadvantaged populations, suggesting instead that appropriately designed packages can leverage price sensitivity among lower-income consumers to achieve progressive health outcomes.
Complementary roles for regulatory measures
The evidence regarding labelling and marketing restrictions reveals more complex equity dynamics requiring careful contextual analysis. Front-of-pack warning labels demonstrate effectiveness in reducing UPF purchasing but exhibit stronger impacts among more educated consumers (Popkin et al., 2021; Langellier et al., 2021). Whether this differential responsiveness improves or worsens inequalities depends upon the current social distribution of UPF consumption in specific populations.
This finding underscores the importance of diagnostic research preceding policy implementation. Understanding which socioeconomic groups consume most UPFs in a given context enables prediction of how differential policy responsiveness will affect inequality trajectories. Where UPF consumption is concentrated among lower-educated groups, labelling alone may prove insufficient and potentially counterproductive from an equity perspective, necessitating complementary measures reaching these populations.
Marketing restrictions hold particular promise for protecting vulnerable groups with limited capacity for critical evaluation of commercial messaging, most notably children. The equity case for comprehensive marketing restrictions rests not on differential effectiveness but on differential exposure: children from disadvantaged backgrounds experience greater marketing intensity for unhealthy products, making restrictions potentially more protective for these groups (Cairns et al., 2013).
The importance of school food environments
School food policies emerge as particularly valuable for reaching children in disadvantaged communities who may have limited access to healthy foods outside educational settings. By directly transforming food environments during significant portions of children’s daily lives, such policies bypass individual behaviour change mechanisms that may work less effectively among populations facing structural barriers.
The potential for targeting school food improvements to disadvantaged areas further enhances equity credentials. Universal provision combined with nutritional standards ensures that children from lower-income families benefit from healthy school meals regardless of household food security status, directly addressing dietary inequalities during critical developmental periods.
Beyond behaviour change: structural transformation imperatives
Critical perspectives in the literature highlight the limitations of policy approaches focused predominantly on individual consumer behaviour (Northcott et al., 2025; Baker et al., 2025). Whilst fiscal measures, labelling, and marketing restrictions all operate primarily through demand-side mechanisms, the fundamental drivers of high UPF consumption are embedded in food production, distribution, and retail systems structured around these products.
The evidence synthesis supports calls for complementing demand-side policies with supply-side interventions that transform food environments, particularly in underserved communities. Incentives for healthy food retail in food deserts, agricultural policy reforms supporting minimally processed food production, and procurement standards for institutional food service represent structural approaches that enable rather than merely encourage healthy choices.
However, the evidence base for supply-side interventions remains substantially less developed than for demand-side measures, reflecting both their more recent emergence in policy discourse and the methodological challenges of evaluating complex system-level changes. Future research priorities should include rigorous evaluation of food environment interventions with explicit attention to equity outcomes.
Toward integrated policy frameworks
The evidence strongly supports integrated policy frameworks combining multiple intervention types rather than reliance on single measures. The most promising configurations pair UPF taxes with subsidies on minimally processed foods, strengthened by labelling requirements, marketing restrictions targeting children, and school food standards prioritising healthy options.
Equity within such frameworks depends on several critical design features. First, subsidies must adequately compensate for the financial burden taxation imposes on lower-income food budgets. Second, supportive measures including healthy food retail incentives must be targeted toward low-income communities facing the greatest structural barriers. Third, intervention selection must reflect contextual understanding of current social patterns of UPF consumption, ensuring that tools are matched to populations requiring support.
The commercial determinants of health literature further emphasises the importance of addressing corporate practices that promote UPF consumption and oppose public health regulation (Baker et al., 2025). Policy frameworks must anticipate and counter industry resistance whilst building coalitions supporting food system transformation.
Conclusions
This dissertation has examined policy options for reducing ultra-processed food consumption through an explicit equity lens, addressing the critical question of how dietary improvements can be achieved without exacerbating existing socioeconomic inequalities. The synthesis of available evidence supports several principal conclusions with direct implications for public health policy.
The first objective, examining fiscal interventions, reveals strong evidence that combined tax-subsidy packages outperform standalone taxation on equity grounds. Whilst UPF taxes effectively reduce consumption, their regressive financial burden requires compensation through subsidies on minimally processed alternatives. The Brazilian and United States modelling evidence demonstrates that such combinations can generate comparable or larger health benefits for lower-income groups whilst protecting their household budgets.
The second objective, evaluating information-based measures, identifies important equity considerations regarding differential responsiveness to labelling by education level. The implications of this differential depend upon baseline consumption patterns, underscoring the importance of contextual diagnostic research preceding policy implementation. Marketing restrictions offer particular promise for protecting children, especially those from disadvantaged backgrounds experiencing greater exposure to UPF promotion.
The third objective, analysing school food policies, confirms their potential for reaching vulnerable children with limited healthy food access outside educational settings. Targeted implementation in disadvantaged areas enhances equity credentials, directly addressing dietary inequalities during critical developmental periods.
The fourth objective, synthesising evidence on combined packages, strongly supports integrated policy frameworks pairing demand-side measures with supply-side food environment interventions. Structural transformation of food retail, production, and pricing systems, particularly in underserved communities, enables rather than merely encourages healthy choices.
The fifth objective, developing policy recommendations, leads to the following conclusions for policymakers: fiscal interventions should always pair UPF taxation with subsidies on healthy alternatives; labelling and marketing restrictions should complement rather than substitute for fiscal measures; school food policies should prioritise disadvantaged areas; and supply-side interventions addressing food environment barriers in low-income communities should receive greater policy attention.
The significance of these findings extends beyond academic contribution to immediate policy relevance. As governments increasingly consider UPF-focused interventions to address diet-related disease burdens, ensuring that such policies advance rather than undermine health equity objectives represents an urgent priority. The evidence synthesised here provides guidance for designing interventions that achieve this dual objective.
Future research should prioritise several areas identified as evidence gaps in this analysis. Longitudinal evaluation of implemented combined fiscal packages would strengthen the currently modelling-dependent evidence base. Investigation of supply-side interventions including healthy food retail incentives requires systematic equity-focused evaluation. Comparative research across diverse national contexts would enhance understanding of how optimal policy configurations vary with food system structures and consumption patterns.
Ultimately, reducing ultra-processed food consumption whilst protecting lower-income populations requires policy frameworks that recognise the structural determinants of dietary behaviour and address them through coordinated intervention across multiple system levels. The evidence reviewed here demonstrates that such frameworks are feasible and that their careful design can achieve health improvements serving social justice as well as public health objectives.
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