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Research

Impact of the North American Free Trade Agreement on high-fructose corn syrup supply in Canada: a natural experiment using synthetic control methods

Pepita Barlow, Martin McKee, Sanjay Basu and David Stuckler
CMAJ July 04, 2017 189 (26) E881-E887; DOI: https://doi.org/10.1503/cmaj.161152
Pepita Barlow
Department of Sociology (Barlow), University of Oxford, Oxford, UK; Department of Public Health and Policy (McKee), London School of Hygiene and Tropical Medicine, London, UK; Stanford Prevention Research Center (Basu), Stanford University, Palo Alto, Calif; Department of Policy Analysis and Public Management (Stuckler), Bocconi University, Milan, Italy.
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  • For correspondence: pepita.barlow@sociology.ox.ac.uk
Martin McKee
Department of Sociology (Barlow), University of Oxford, Oxford, UK; Department of Public Health and Policy (McKee), London School of Hygiene and Tropical Medicine, London, UK; Stanford Prevention Research Center (Basu), Stanford University, Palo Alto, Calif; Department of Policy Analysis and Public Management (Stuckler), Bocconi University, Milan, Italy.
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Sanjay Basu
Department of Sociology (Barlow), University of Oxford, Oxford, UK; Department of Public Health and Policy (McKee), London School of Hygiene and Tropical Medicine, London, UK; Stanford Prevention Research Center (Basu), Stanford University, Palo Alto, Calif; Department of Policy Analysis and Public Management (Stuckler), Bocconi University, Milan, Italy.
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David Stuckler
Department of Sociology (Barlow), University of Oxford, Oxford, UK; Department of Public Health and Policy (McKee), London School of Hygiene and Tropical Medicine, London, UK; Stanford Prevention Research Center (Basu), Stanford University, Palo Alto, Calif; Department of Policy Analysis and Public Management (Stuckler), Bocconi University, Milan, Italy.
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Abstract

BACKGROUND: Critics of free trade agreements have argued that they threaten public health, as they eliminate barriers to trade in potentially harmful products, such as sugar. Here we analyze the North American Free Trade Agreement (NAFTA), testing the hypothesis that lowering tariffs on food and beverage syrups that contain high-fructose corn syrup (HFCS) increased its use in foods consumed in Canada.

METHODS: We used supply data from the Food and Agriculture Organization of the United Nations to assess changes in supply of caloric sweeteners including HFCS after NAFTA. We estimate the impact of NAFTA on supply of HFCS in Canada using an innovative, quasi-experimental methodology — synthetic control methods — that creates a control group with which to compare Canada’s outcomes. Additional robustness tests were performed for sample, control groups and model specification.

RESULTS: Tariff reductions in NAFTA coincided with a 41.6 (95% confidence interval 25.1 to 58.2) kilocalorie per capita daily increase in the supply of caloric sweeteners including HFCS. This change was not observed in the control groups, including Australia and the United Kingdom, as well as a composite control of 16 countries. Results were robust to placebo tests and additional sensitivity analyses.

INTERPRETATION: NAFTA was strongly associated with a marked rise in HFCS supply and likely consumption in Canada. Our study provides evidence that even a seemingly modest change to product tariffs in free trade agreements can substantially alter population-wide dietary behaviour and exposure to risk factors.

  • Accepted April 27, 2017.
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Canadian Medical Association Journal: 189 (26)
CMAJ
Vol. 189, Issue 26
4 Jul 2017
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Impact of the North American Free Trade Agreement on high-fructose corn syrup supply in Canada: a natural experiment using synthetic control methods
Pepita Barlow, Martin McKee, Sanjay Basu, David Stuckler
CMAJ Jul 2017, 189 (26) E881-E887; DOI: 10.1503/cmaj.161152

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Impact of the North American Free Trade Agreement on high-fructose corn syrup supply in Canada: a natural experiment using synthetic control methods
Pepita Barlow, Martin McKee, Sanjay Basu, David Stuckler
CMAJ Jul 2017, 189 (26) E881-E887; DOI: 10.1503/cmaj.161152
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