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A TAX on sugary drinks should be on the table as part of a comprehensive strategy to tackle Australia’s rising obesity rates, say leading public health experts.
The call comes after the federal government ruled out following the UK’s lead in applying a levy to sugary drinks.
Professor Garry Jennings, National Heart Foundation CEO and Chief Medical Advisor, said a sugar-sweetened beverage (SSB) tax should be considered as part of a comprehensive obesity plan.
“We understand that governments vary in terms of their appetite for a tax like this, but given that the UK has done it, along with Mexico, South Africa and a number of other countries, it’s certainly something that ought to be in the policy mix,” Professor Jennings told MJA InSight.
“But there is no simple fix for rising obesity and there is no single policy that will achieve what we want. Like tobacco and road safety, it was never one initiative. We need sticks and carrots for public health measures to be effective.”
- Podcast with Prof Rob Moodie and Ms Jane Martin
- Related: MJA — Alcohol and tax — time for real reform
- Related: MJA InSight — Volumetric tax best way for alcohol reform
- Related: MJA — Government action on diabetes prevention: time to try something new
In March, the UK Government announced plans to tax sugary drinks with a levy applying to drinks with a total sugar content above 5g per 100mL, and a higher rate for drinks containing more than 8g per 100mL. Fruit juices and milk-based drinks will be exempt from the tax.
The tax will be introduced in 2018, giving manufacturers the opportunity to reformulate their products, with the funds raised earmarked for primary school sport programs.
The UK joins France, Belgium, Hungary, Mexico and Scandinavian countries, which have all imposed levies on drinks with added sugar.
Mexico’s tax, introduced in 2013, resulted in a 6% drop in beverages purchased in its first year, with the greatest reduction among households with the lowest socio-economic status.
Assistant Health Minister Senator Fiona Nash has ruled out such a tax in Australia, telling Sky News that the government did not think an SSB tax was the way forward. “It’s about people being informed, and making those choices and making them responsibly,” she said.
Professor Jennings said there needed to be a levelling of the playing field to support consumers in making healthier choices.
“Big Food has very effective marketing mechanisms. The availability of sugary drinks is extraordinary – you can’t go anywhere in remote Australia without finding some – you mightn’t be able to find fruit and vegetables, but you can always find a sugary beverage,” he said.
Professor Timothy Gill, Professor of Public Health Nutrition at the University of Sydney, said “everything should be on the table” in trying to tackle rising obesity, particularly childhood obesity.
“I wouldn’t criticise a government that took a long, hard look at [a tax] and then decided the negatives outweighed the positives, but ruling things out is not very helpful, particularly in a situation where we need every tool to address this issue.”
Professor Gill said consumption patterns of sugary drinks in Australia were concerning, with adolescents and young adults being the largest consumers.
“The soft drink industry says that they only contribute something like 2-4% of the total energy of Australians, and that’s true if you include everyone. But if you look at those large consumers – and that’s the teenagers and young adults – then it contributes somewhere between 10% and 15% of their total energy and about a third of their total added sugar intake,” he said.
He added that this energy intake came with no nutritional benefits, making sugary drinks an “important and appropriate target” for a tax.
Professor Gill said the UK tax model was flexible and volumetric, which dealt with the issue of the “incredibly cheap” pricing of sugary drinks and encouraged manufacturers to reformulate their products.
He said an SSB tax not only sent a price signal to reduce consumption, but also signalled that a government considered the consumption of excess sugar to be a serious health issue.
It was this messaging that Professor Anna Peeters, Professor of Epidemiology and Equity in Public Health at Deakin University, said was one of the most important aspects of a tax.
“Governments standing up and making big policy changes is going to have long-term effects above and beyond that policy itself. It’s setting a line in the sand and saying health is important and we are going to stand up for consumers’ health.”
Professor Peeters said it was “just a matter of time” before a similar tax was introduced here. She said there was growing acceptance internationally that obesity and unhealthy diets were going to be a major contributor to ill health, and to productivity and economic loss, and that action needed to be taken.
She said Australia had introduced the health-star rating system in 2014, and the UK’s SSB tax plan was another good example of governments taking this issue more seriously.
Professor Peeters also pointed to an initiative in Philadelphia, US, which was seeking to introduce an SSB tax, with money raised used to fund universal preschool and other community projects to make the measure more palatable to voters.
“Australia is grappling with this issue, the same as everybody, and my expectation is we will see a SSB tax come in in the next 5 years,” she said. “It’s just a matter of seeing how it works in other countries and then putting it in place.”
Speaking in an MJA podcast, Ms Jane Martin, executive manager of the Obesity Policy Coalition, welcomed the UK tax, but said that a 20% excise-style tax would be preferable to the UK approach.
She said politicians were currently lagging behind public sentiment on this issue, with 85% of Australians supporting the use of the revenue from a sugary drinks tax being used to fund childhood obesity prevention programs.
“The public is over the line, it’s the politicians and the public health groups who need to catch up,” she said.
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Science does not imply policy or the need for it. As Hume would put it, we cannot get to ‘ought’ from ‘is’.
Anyone advocating for a sugar tax should understand where they draw their own ‘bright line’, what measurable criteria they are using to decide when it’s acceptable for govt intervention to manipulate behaviour: What makes a sugar-sweetened drink tax any more justifiable than one on juice? How about if vitamins were added? More justifiable than lactose-enhancement? Or tooth-destroying carbonic acid? What about sugary foods, high-carb crisps or deep-fried foods? Should the tax simply reflect the cost to the rest of society (in which case cigarette taxes should be radically reduced), or should it be punitive? How about one on fat people — maybe 1% of income for every BMI point >25? Or a couch-potato tax — scaled on time beyond 2 hours spent watching TV or less than 20mins aerobic exercise daily? With no ‘bright line’, such policies that you may intuitively vehemently oppose become immune to rational criticism and should be expected.
Views on the importance of autonomy, the degree of “behaviour modification” we should tolerate, whether responsible drinkers should be punished, the desirability of increasing regressive taxes or taxes generally, whether we should trust the govt to spend our dollars wisely, whether we really have explored & tried enough alternatives, and so on, are not those where doctors hold any specialised knowledge. Advocating for govt intervention by citing data while dismissing the importance of separating ‘ought’ from ‘is’ is both arrogant and myopic — medicine has no hold on what ought to be.
Education doesn’t work – obesity rates are the same for medical professionals including doctors, some of our most educated and supposedly clever people, as they are for the general public according to ABS data.
Any difference among study authors’ perceptions could also be reflecting differences in expertise. Case in point: the meta-analysis proposed by Dr. Stanton as evidence of significant association between sugar beverages and T2DM. Meta-analyses of observational studies are of particularly questionable value to statisticians, because such studies almost universally show large heterogeneities, the death knell of any meta-analysis (as far as any consideration of treatment effect is concerned). Indeed, as the authors report,
(http://www.bmj.com/content/351/bmj.h3576) To a statistician, such large heterogeneities (I2 being the estimate of the percent variance among study results that is attributed to heterogeneity) render attempts at quantifying effects useless. The value of a meta-analysis with such large heterogeneity lies solely with its analysis of the causes of that heterogeneity. Indeed, the authors admit not being able to explain it.
Surely other studies could be cited that better support a pro-tax argument. Nonetheless, no studies to date imply an arbitrarily applied tax of arbitrary magnitude will give any health benefit, which is surely what advocates are lobbying for. Where is the outcomes data? Consider the finding that drinking artificially sweetened ‘diet’ drinks does not lead to the (public’s expected) benefit of weight loss, presumably because the sweetness itself leads drinkers to seek out other sweets.
Dr. Stanton,
That basic economics dictate sales will decrease w/ increased price is not controversial. Assertion of the connection does not help with policy development. To begin with, How elastic is that supply-demand curve? If taxes of, say, 20% decrease consumption by a mere 1%, is this an argument to double the tax, make it 100% on the order of cigarettes, or scrap the idea altogether?
While sugar consumption generally has been implicated in diabetes, the studies you cite do not support a tax on sugary drinks.
The PLoS study you reference says essentially nothing of consequence:
Yes, industry will try to put a positive face on their studies (assuming ‘conflict of interest’ suggests industry-influence), but the different conclusions as stated above do not contradict one another (“could be a potential risk factor” is not mutually exclusive from “evidence was insufficient to support a positive association”), and therefore this unenlightening finding as reported cannot be used to argue that the quantified results in those groups of studies are systematically any different.
If a tax raises awareness about the fact that Australians are consuming up to one kilogram of suger per week and prompts people into changing their diet, it is a good thing.
Thanks for this very intersting article.
I think an SSB tax is one tool in a whole range that the government should seriously consider. It is doubtiful that any one tool will prove to be a silver bullett, hence, there needs to be whole range of strategies used to fight obesity. An SSB does have the advantage that it is highly vissible and impacts anyone who chooses to purchase these drinks. Given that these drinks do not appear to offer any nutritional benefit to the consumer a tax on the drinks would not adversely impact the consumer as they could simply make the decision to reduce their intake. I can not see any down side to introducing an SSB tax but should be done in conjunction with other strategies.
There is good evidence that increasing the price of sugary drinks decreases consumption. There is also good evidence that decreasing sugary drinks reduces obesity, although studies funded by beverage companies do not get the same results (http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001578)
Kilojoules in liquid form do not blunt the appetite and humans seem to make no compensation for them by consuming less of anything else.
In a meta-analysis of 17 studies representative of almost 230 million adults in the U.S. and the U.K., the incidence of type 2 diabetes increased by 18% for every extra daily serving of sugar sweetened drinks such as soft drink or juice with added sugar. When the data were adjusted for obesity, the increased risk was still 13% for each serve (an a serve in this study was just 250 mL – much less than a can or bottle).
Sugar sweetened drinks also increase dental erosion. Here it is not only sugar but more importantly the acidity of the products that is the problem.
There is no doubt that Australia needs to decrease consumption of sugar sweetened drinks. As soon as any price increase is mentioned (whether as a tax or an increase for container deposit), the beverages industry spring into action. That’s surely enough evidence that price increases lead to decreased sales.
No one is suggesting that decreasing intake of sugary drinks will solve the problem of obesity. No single action will ever do that for a multi-factorial problem. But such an action surely represents the low hanging fruit. The major reason not to do this seems to be conflict of interest .
Yes, more tax, let’s have more tax! More money that could be spent on direct patient management, but won’t be. While we are about it, GPs should receive the announced chronic disease management payments only if they have recorded each patient’s expenditure on and tax generated from SSBs in their MyHealth record! It’s all BS.
What the hell would the Coca Cola conglomerate care if SSBs were taxed? It probably makes 10s to 100s of multiples of profit per unit selling Australian water to Australian suckers. Even if it didn’t, there’s plenty of time to plan changes in marketing and sell more sugar to the more affluent. Addicts are addicts to the bottom line! Same for their competitors who will surely include new and healthy product lines outside the new taxes: like those Sanitarium has offered to the populace for the last couple of decades. Full of garbage, no health benfits and with unrealistic or no tax paid to the rest of us (Sanitarium is owned by a church).
Polititians and bureaucrats have no idea about health care and nutrition. This is the best they can come up with after low fat, no fat? Pffff. Forget they subsidise and support our sugar industry and fail to extract tax from huge companies profiting from the sugar trade! If they taxed corporates like the rest of us rabble there would be a populace with the affluence to afford healthy nutrition and this may be a lesser issue.
This tax is an ineffectual con and not because sugar is good. It isn’t; it’s bad and borerline unnecessary to humans. Seems like our profession is easily conned though and our figure-heads will go for this without thinking past the chance to have a say.
Yes, individuals have the right to choose to do harmful things. They make such decisions every day. Unless one thinks it appopriate for government to micromanage everyone and to tax ALL harmful food/behavior, it makes little to no sense to arbitrarily tax sugary drinks.
As to tobacco, smokers pay about 5 times their economic cost to the rest of society (most notably, to our socialized healthcare system). Politicians like to pretend that they don’t pay their fair share, but such is the nature of a morally bankrupt government going for the easy tax grab to justify yet more spending — when former Health Min Roxon and PM Rudd claimed the cost of smokers to be $30billion annually (with tax revenue of about $5billion), they included and were thus arguing we should tax, among other things, the cost to the smoker of purchasing cigarettes, which itself is about 80% tax! Insanity. Yet the masses were and continue to be easily fooled.
Like many of the comments above, I agree thet a tax on sugary drinks is nonsense, retrogressive and just a political ‘smokescreen’ for cheap misguided gain, just like the’Carbon Tax’ ! The average working ‘man’ in Australia is already ‘taxed to death’ (viz King John of England!). It is just another excuse to not tackle the real issues! In any case, if you want to, those who should be taxed are the Providers and Distrubuters of the ‘sugary drinks’ – like Coca Cola, Coles, Woolworths etc who discount the prices so much and put the products ‘in your face’ in their stores and media advertising – which should be addressed, as with cigarettes. Not The Poor Downtrodden Taxpayer!! In any case sugar only provides 4 Kcal per gram, whereas fat and protein provide 10! So why not tax all food?! Seriously Stupid and wiil certainly have little effect on obesity! As always the sensible answer is education, support and most importantly reduce taxation so that people can afford quality food and maybe even subsidise / reduce the price of so called ‘healthy foods’
Well non-sugar drinks can be cheap, can buy plain mIneral water for 70c per bottle! We can look at ways of making healthy alternatives available . We need a sugar tax as part of the process of creating ‘norm’ ie the right culture for avoiding unhealthy options. Remember how we did this with tobacco smoking. Every bit of effort counts to create the right environment for lifestyle improvement. Go on let’s tax em!
It is not just about obesity, which would be more than enough reason to tax sugar. The excessive sugar intake in western diets is the key cause of metabolic syndrome which is estimated to be a burden on the Australian economy of about $58bn. And yet some argue that individuals have the right to harm themselves, influenced by the markting and ubiquitous availability of poor nutrition SSBs and processed foods. Unless you think it was wrong for the government to address the harm to our health from tobacco, you MUST support a sugar tax!
People living in poverty buy sugary drinks because they’re the cheapest form of calories, despite being nutritionally inadequate. Instead of increasing the cost, how about subsidising healthy food? Or subsidising transport costs of food to those remote communities mentioned above. See Brindlecombe who investigated whether income management resulted in people buying more fruit and vegetables, and concluded that “it is unlikely that mandatory management of people’s income will lead to purchasing of more fruit and vegetables when issues of availablity, quality, affordability and home storage remain key issues.” MJA 2010: 192(10): 549 -554. Similarly, increasing the cost of sugary beverages by a tax is unlikely to increase purchasng of fruit and vegeables when poverty is a driving determinant.
Why is it that increasingly, many health professionals reflexively call for dubious yet creeping government paternalism in response to every health issue, as if an advocate for one implies the other? Were they under-exposed to ethics training in medical school (and their former lives)? Have they lost the ability to critique observational studies out of dissonant ideology, or incompetence? Are they not cynical of government oversight or themselves self-interested government apparatchiks? Or are they simply too lazy to argue for preventive medicine strategies that respect autonomy?
Taxes on sugary drinks are arbitrary, have not been shown to effect health benefits anywhere, invariably will get pooled with every other tax despite initial promises to ‘earmark’ revenue (as if tax revenue ever worked in any other way), is regressive, is dismissive of autonomy, and logically nudges the door open to yet more invasive, arbitrary, freedom-sucking, nanny-state socialist bureaucracy that has no apparent end aside from extending itself.
@ Martin Barrymore. Nobody said that an SSB tax would be a silver bullet to the obesity epidemic. To say that this article is infering that is a misreresention. Uness you agree that large volumes of sugar are a healthy alternative to fresh fruit & veg then an SSB tax surely cannot hurt?
We are lucky enough to live in a country which encourages free speech and everyone is entitled to their own opinion which in this case is ovewhelmingly in support of a tax on SSB. Have a look at the poll results.
While I do believe that sugar is the major cause of obesity, especially in children, the sugar tax may not be the main solution. However, if the proceeds from a sugar tax can be quarantined to directly support the other evidence based activities that reduce obesity, then surely it would be a good thing for our already stressed health system.
Sensible and will be helpful
I’m sorry – but a tax on SSBs is nonsense. It’s not new: the attacks on sugar date back to at least the 1960s with Yudkin’s book “pure, white and deadly”. The increase in obesity/overweight levels are surely multi-factorial and probably include: lack of exercise, more time behind computers or smartphones and iPads; the loss of a sporting ethos at so many schools; the reality of children now being driven to school instead of walking or cycling; and, yes, for some – terrible diets. But, to argue that a tax of sugar-sweetened drinks will do anything to stem the obesity tide is the manifestation of hope over reality. There is no ‘silver bullet’ here; there never has been.
All the dimwits over the years who have written books about “How I gave up sugar” are, almost to a person, not qualified to make any comments in respect of nutrition.
There was no study, there was no supervised management of what it was they were claiming to eat or not to eat. Thus, when you looked more deeply into what they gave up – they gave up sugar-containing foods and drinks. Things like chocolate, cakes, muffins – ‘well, what about the fat you didn’t eat as a consequence of those decisions – wouldn’t that have made a difference to your propensity to lose weight?’ No answer: These realities get in the way. A tax on sugar-sweetened drinks will make not the slightest difference to overweight kids. None. But that won’t stop the ideologues.
Time to leave ideology out of these discussions: science only. Nothing more.
BTW, sugar doesn’t just sweeten. It also preserves.