Sixty-four countries have now placed a tax on sugar-sweetened beverages—a policy shift that is reshaping how the world confronts one of the most preventable sources of diet-related disease. The acceleration is striking: nearly half the world's population, 3.5 billion people, now lives under a national sugar-sweetened beverage tax implemented since 1990, according to new research from Tufts University's Food is Medicine Institute published in The Lancet Global Health.
The disparity in adoption reveals something unexpected about how governments make health decisions. Countries in South Asia lead globally, with 50% having adopted such taxes, followed closely by Southeast and East Asia at nearly 48%. High-income countries have adopted them at a slower pace—just 29% overall—while Central Eastern Europe and Central Asia show the lowest adoption rates at 17%. But what drives these choices turns out to be counterintuitive.
Lizbeth Moreno Loaeza, who led the study while at the Friedman School and is now at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City, discovered that a country's actual consumption of sugary drinks had no significant relationship with whether it chose to tax them. Instead, the burden of Type 2 diabetes and obesity—the diseases these beverages help cause—emerged as the primary motivator. "Surprisingly, the consumption rates of sugar-sweetened beverages had no significant relationship with whether a country chose to tax them, suggesting these decisions are driven more by disease burdens," Moreno Loaeza explained.
The research, drawn from analysis across 183 countries using Global Dietary Database and World Bank data spanning 1990 to 2024, also revealed that countries with higher social and health development were paradoxically less likely to adopt these taxes, regardless of economic wealth. This may reflect the fact that wealthier nations with more robust health systems experience lower rates of diet-related disease and therefore face less urgent pressure to act.
When countries do implement taxes, the approaches vary widely. Tax rates range from 1% to 34% across the 64 nations that adopted them, with the highest median rates in the Middle East and North Africa. Most countries tax based on price or volume, but only a small fraction have tied taxes to actual sugar content—an approach researchers argue may prove most effective because it incentivizes beverage companies to reformulate products with less sugar.
A troubling gap remains: only 13% of countries directing tax revenue toward health programs, missing an opportunity to amplify the public health benefits. The stakes of inaction are clear. A 2025 study in Nature Medicine found that sugar-sweetened beverages now contribute to 2.2 million new diabetes cases and 1.2 million new cardiovascular disease cases globally each year. Dariush Mozaffarian, senior author and director of the Food is Medicine Institute, noted that "we know these taxes work, and we now have a much clearer picture of how they are being adopted and what drives countries to do so."
What began as a health recommendation from the World Health Organization and American Heart Association has become a concrete policy tool reshaping beverage markets worldwide. The question now is whether countries will complete the picture by reinvesting tax revenue into the health systems these diseases burden.