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“The state has no authority to subject people to death and injury in certain kinds of … accidents just because it hopes others will be saved in other kinds of accidents … The state has no authority to take chances with a person’s body, the ultimate private property”
THAT quote is from a website opposing compulsory seatbelts, but it could just as easily be from one that opposed vaccination, fluoridation of water supplies, or any one of a raft of other public health interventions.
Government attempts to encourage healthier behaviour in citizens will always expose tensions between the rights of individuals to make choices about their lives and the welfare of the community as a whole.
Particularly when the intervention relies more on the stick than the carrot: education and health incentives are one thing, penalties and taxes quite another.
You only have to look at the decades-long fight against increasing regulation and taxation of tobacco products to see how desperate the opposition can be.
With the battle against Big Tobacco well advanced, at least in the developed world, the new frontline appears to be sugar.
As the obesity rate continues its upward spiral, accompanied by its chronic disease mates, governments and public health advocates are on the lookout for strategies to reduce the burden on the public purse.
One idea that keeps cropping up is that of a sugar tax.
Such taxes are often criticised for being regressive, because people who earn less pay more as a proportion of their income than do wealthier people.
That’s generally the case with any consumption tax (unless it’s on polo ponies or private Learjets). The same charge has been levied against tobacco excise.
If people on lower incomes are hit harder by a new tax, the argument goes, they may have less money to spend on necessary, healthy items such as fruit and vegetables, leading to worse health outcomes in the long term.
That assumes no change in behaviour, and behavioural change is, of course, the point.
It’s a hard point to pin down, though.
Smoking rates have been on the decline in recent decades in Australia and elsewhere, but it’s no easy task to determine how much of the credit goes to increased tobacco excise and how much to the multitude of other anti-smoking initiatives governments have implemented.
A group of Australian researchers have, however, risen to the challenge of trying to work out how a tax on sugary drinks might affect consumer behaviour, particularly that of people on lower incomes.
Unsurprisingly, their modelling suggests that such a tax would have more financial impact on people at the lower end of the socioeconomic scale, although with the additional cost estimated at 60c per week with a tax of 20%, the cost to the individual is relatively small.
Would such a small increase in cost change behaviour? These researchers draw on overseas experience to argue it would, and that the effects would be greatest in lower income households.
While the tax itself might be regressive, they argue, the health gains experienced by those in the lowest socioeconomic categories could mean that they ended up better off over all, even on a purely financial level.
After all, health care costs also represent a higher proportion of income for people on lower incomes.
For the health system as a whole, the researchers estimate that the tax could lead to savings of $1.73 billion across the lifetime of the population cohort.
It would also raise an estimated $643 million annually, money that could be used to help allay concerns about the tax’s disproportionate impact on those with low incomes.
“There is evidence in Australia that earmarking the tax revenue for subsidising healthy food, tackling childhood obesity, and supporting children’s sport and health promotion initiatives would raise the public support for such a tax,” the researchers write.
Do I hear cries of “nanny state”?
You could argue that it’s just good economic rationalism to expect the purveyors of unhealthy products to contribute to covering the costs those products go on to impose on the health system.
And, if we’re talking individual liberty, it’s worth asking how much freedom we consumers really have in a world where misleading food labelling makes it hard to know exactly what we’re eating and healthy foods cost considerably more per kilojoule than the fatty, sugary junk that is increasingly part of our diets.
Disclosure: Jane McCredie ate a chocolate brownie while writing this article.
Jane McCredie is a Sydney-based health and medicine writer.
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The Government doesn’t care about healthier communities or healthier people or the disease burden or obesity. If they did, many foods would be prohibited for sale in supermarkets and other outlets. They are the food-like-edible-substances that so many people currently consume. They are too available.
The Government cares about economics and their vested interests (their “buddies”) in the Food Industry and in keeping sugar-cane farmers in business, as an example. Revenues, economics and personal wealth/interests are far too important to Government, political parties and MPs to stand up to any Public Health challenge to seriously address our rising rates of Obesity, Diabetes and other chronic diseases (arthritis, joint problems, blood pressure, CVD, inflammation, cancer, fatty liver disease…..).
If a tax is to be introduced, it should be a FNT; ‘Food-nutrient tax’, which would apply to anti-nutrient foods that have been proven to cause bodily harm. That is foods that contain unhealthy levels of trans-fats, salt content, sugar-content, inclusion of artificial sweeteners to name the main offenders. That way, we wouldn’t be arguing about sugar alone and it would apply to all foods that do not provide nutrition. However, this would be all too sensible it seems. The Grattan Institute conducted some very interesting modelling to indicate how this would impact price of commonly purchased junk foods. They become much less attractive and would theoretically force or encourage food companies to reformulate.
I’m afraid I’m a cynic. This is because every-day as a Dietitian working in the Community I spent countless hours trying to educate clients about the impact of their food intake. Some are interested and I have some wins which keeps me going. The majority are not as engaged as they have other stressors, like paying their electricity bill, or a recent death in the family, or what to do about their abusive partner, or the chronic pain that stops them from sleeping and exercising. Or it could simply be that life is too awful for some individuals that they are happy to accept the consequences of that KFC meal for the immediate enjoyment it brings, rather than caring about the possibility that in 10 or 20 or 40 years, they may end up with hypertension or Diabetes.
Although it may be tagged a regressive tax, I agree that Obesity in itself is in fact regressive and we need to do more to support Australians to make healthier choices. Not only because it is more economically viable and sustainable to do so for the sake of our health system, but because it is the ethical thing to do.
I love the idea of buying a bag of steamed broccoli! Not only because I’m a Dietitian, but because I actually like it and was fortunate enough to have been brought up to enjoy veggies and know that they can taste good too.
One frustrated Dietitian.
A lawyer friend lost a lot of weight on the Atkins diet, which worked on the principle of “if you are hungry eat a steak, if you are still hungry, you have to cook another steak.”
But he felt the main weight loss determinant was that he was unable to find any fast food which complied with the diet, working in the Sydney CBD. Although taxing sugar is highly regressive, because poor people have to eat as many calories as rich people, the obesity burden is also highly regressive, being worse on the poor in Western societies.
Mandating some sort of cheaper and healthy food in all fast or slow eateries would be beneficial, much like the legislation which requires all places to provide free tapwater. If every provider from McDonald’s to Quay were required to serve a plate of steamed vegetables or a simple green salad for under $5, with no cover charge or no minimum per capita spend required, there would be a viable option for low-calorie dining.
Walking up Macquarie Street (Sydney’s medical specialist Mecca) after reading this article, I saw lots of chocolate brownies and similar food for sale, but nowhere that offered a take away bag of steamed broccoli.
For the avoidance of doubt, I’ll state at the outset, I am pro-preventative public health policy. Clearly health education is insufficient to drive behaviour change. We’ve known this for a long time. We have seen in the past 3 decades, the obesity and overweight numbers of Australians steady climb. The costs to our economy are estimated by Nicholas Gruen to be in the order of $120B. Yet government’s have been reluctant to do more than fund modest health education campaigns and address food labelling.
We also known that access to fresh food and the costs of both junk food and fresh produce, affects consumer behaviours. But a tax may not be the magic bullet on obesity. The research cited here should be cause for careful consideration. Public policy responses should not add to the burden of disadvantage already experienced by those on low incomes who have lower access to affordable health care and higher access to junk food (as in numbers of outlets in disadvantaged areas).