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TAXES on unhealthy foods, not subsidies on fruit and vegetables, are effective at reducing the burden of obesity, new research suggests, amid renewed clamour for a sugary drinks tax.
Researchers at the University of Melbourne have found that a subsidy on fresh fruit and vegetables would not on its own produce health gains, because it would lead to an undesirable increase in sodium and energy intake.
However, adding a subsidy to a package of taxes on sugar, fat, salt and sugar-sweetened beverages could be effective, they wrote. The combination of taxes plus the subsidy could avert 470 000 disability-adjusted life years and save $3.4 billion from the health budget, the modelling study found.
The study drew on detailed New Zealand price–elasticity data – which track variations in product uptake with changes in product prices – to quantify disease risk reductions associated with each change in risk factor exposure.
A sugar tax would be most cost-effective, the study found, followed by a salt tax, a saturated fat tax and a sugar-sweetened beverages tax.
Writing in the journal PLOS Medicine, Dr Linda Cobiac and colleagues said that their findings added to the “growing evidence of large health benefits and cost-effectiveness of using taxes and regulatory measures to influence the consumption of healthy foods”.
The findings about the subsidy might at first appear counterintuitive, they said.
“However, using price subsidies or discounts as an incentive to purchase more fruits and vegetables may have the effect of increasing real income available to buy food, including unhealthy products, and could therefore lead to an overall increase in dietary measures such as saturated fat, sodium, or total energy intake,” they wrote.
The federal government is facing growing pressure from public health advocates to tax sugary drinks, with the Australian Greens pledging to introduce a bill on the measure later in 2017.
Writing in the MJA, the University of Sydney’s Professor Stephen Colagiuri urged the government to make the tax a priority as part of a multicomponent strategy against obesity.
That call was echoed in a separate report released last week by the Obesity Policy Coalition, whose member organisations include Cancer Council Victoria, Diabetes Australia (Victoria) and Deakin University.
In his MJA article, Professor Colagiuri cited the introduction of Mexico’s sugary drinks tax in 2014, which was followed by a 12% decline in the consumption of taxed beverages and a spike in bottled water consumption.
“The ongoing impact of [Mexico’s] tax has been challenged with new data suggesting a small increase in sales of SSBs [sugar-sweetened beverages] in 2015, but still lower than the increase in pre-tax sales,” he wrote.
“Arguments that an SSB tax is an ineffective means to reduce consumption are inconsistent with food industry claims of potential damage and job losses, which instead may point to the industry believing that a tax would substantially impact consumption.”
Professor Colagiuri noted that Australia was among the largest global markets for sugar-sweetened beverages, with males aged 4–30 years drinking an average 750 mL (two cans) per day.
“Government pays for health services and consequently has a right and duty to address externalities to promote and protect public health,” he wrote.
However, the federal government last week continued its resistance to any form of sugar tax, with health minister Greg Hunt commenting: “We’re committed to tackling obesity, but increasing the family’s weekly shop at the supermarket isn’t the answer.”
Decrying the proposed tax as a “nanny state” response, assistant minister for health, Dr David Gillespie, noted that Denmark had repealed its sugar tax and dropped plans for a tax on saturated fats.
The peak Indigenous health body, National Aboriginal Community Controlled Health Organisation (NACCHO) also expressed reservations about the tax to MJA InSight.
NACCHO Chair Matthew Cooke said: “The high costs of transporting food and groceries to remote communities mean that Aboriginal and Torres Strait Islander people in these areas are already paying inflated prices for these types of products, and all other grocery items.
“These communities are also less able to pay higher costs and have limited access to alternatives, particularly fresh fruit and vegetables – which, because of the long distances they need to be transported, are often past their prime and overpriced when they arrive,” he said.
“Reducing sugar consumption is critical to reducing chronic health conditions, including diabetes; however, there needs to be more work done on how these issues would be overcome before NACCHO could support any tax-based approach such as a sugar tax.”
Indigenous affairs minister, Nigel Scullion, said in 2016 that sugary drinks were “killing the population” in remote communities, after the senate heard evidence of an “astounding” level of soft drink sales at remote community stores.
David Butt, CEO of the National Rural Health Alliance told MJA InSight that his organisation supported “the possibility of taxing sugar-sweetened beverages and using the revenue to subsidise access to healthier food options”.
Professor Andrew Wilson, director of the Menzies Centre for Health Policy at the University of Sydney, said that compared with taxing sugar per se or salt, the proposed tax on sugary drinks had “the virtue of being fairly easy to define”.
“However, these drinks are so cheap to make that the tax will need to be substantial,” he added.
A recent report by the Grattan Institute recommended that sugar-sweetened beverages be taxed at a rate of 40 cents per 100 grams of sugar, increasing the price of a 2-litre bottle of soft drink by 80 cents. This would raise about $500 million a year, according to the Grattan Institute, which predicted a resultant 15% drop in consumption of sugary drinks and a small decrease in obesity rates.
Professor Wilson stressed that any taxation approach should be “part of a package that includes education and support for good nutrition, promotion and facilitation of physical activity, with particular focus on school-aged and older teens, planning considerations and, possibly for some areas and groups, subsidies for fruit and vegetables”.
Dr Cobiac agreed, commenting: “Our modelling shows that the potential health benefits of using taxes and subsidies to improve dietary choices and the nutritional quality of our foods in Australia are huge, but ultimately, they are just one of a number of measures that are needed to tackle obesity.”
Dr Cobiac noted that 13 other countries had announced taxes on unhealthy foods or sugar drinks in the past 5 years.
“It was true that Denmark had revoked its policies,” she said; however, she added that it was likely that as early initiators “they did not fully foresee or plan for dealing with the resulting backlash from the food industry”.
“We will never know what effect the taxes would have had in Denmark; they were repealed before there was a chance to properly evaluate them,” Dr Cobiac said.
“While many people want to eat better and lose weight, it is not easy to sustain the changes in behaviour when we live in an environment where unhealthy foods are widely available, heavily marketed and cheap.
“That environment is unlikely to change without a really comprehensive strategy to tackle the obesity problem.”
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There may also be a case for plain packaging as well as advertising control. Imagine how “unattractive” most of our supermarkets would be if all high sugar foods and beverages were wrapped in white packaging/bottles and black labels. Suddenly the fruit, vegetables and fresh meats would be the most attractive items on offer!
Education, education, education!! Where is ‘health’ on the syllabus at our schools? What public education is there on nutrition despite the valiant efforts of the likes of Rosemary Stanton. We might as well tax cars even more more as we kill lots of people with them! And it has been well pointed out that sugar alone is not responsible for our health woes. Logically we need more put GST on food, however no government would seriously consider this.
What will the food industry use to replace ingredients that are taxed? Instead of sugar in foods will they use starches and intense sweeteners? Metabolically very little difference between starch and sugar. Will saturated fat be replaced with unsaturated fats that may be less heat stable and produce byproducts may have other health risks? Will consumers go back to adding more salt during cooking and at the table to processed foods with lower salt levels? Research needs to be on the whole diet outcomes if some processed foods carry an additional tax. We know that how the food industry meet consumer demand for low cholesterol and low saturated fat foods did not always result in a “healthy” food. Perhaps as a community we need improved cooking and gardening skills so we rely less on highly processed foods.
Lot’s of salient comments from Rosemary and Roger. I do not believe that drinks alone are the major cause of obesity. As always if you put more calories in than you need or use in exercise the extra calories are stored as fat, period! We need to return to the era of good home cooking and stop eating out at expensive restaurants and quick take away options which are loaded with fat and sugar. Then and only then can we begin to tackle the problem of obesity.
Oh great, another tax and it worked so well on cigarettes!. We are one of the most highly taxed countries in the world! We need a new paradigm to tackle this problem and we doctors should be able to come up with one. What about tax deductions for people who loose weight?
We do know what to do, but the political power of the processed food industry means we get obstruction to anything that might decrease sales of its products. Junk food and drinks contribute 35% of adults’ and over 40% of children’s energy intake. That is the elephant in the room and we need multiple actions to tackle it. A sugar tax is one that is simple to implement, especially applied to drinks.
Even more importantly, we need to stop promoting junk food and drinks. That means stopping advertising these products during TV programs that children watch. It means sporting teams and sports heros not acting as walking billboards. It needs bans on advergames for children where product placement of junk foods and drinks are visible for the time spent playing the game – which may be 30 minutes. It needs schools to stop selling children junk food and drinks from the school canteen (which negates anything they might learn in the classroom).
We also need to talk about foods rather than nutrients. The Dietary Guidelines talk about foods. Sadly, almost no one follows them – as shown by the fact that less than 7% eat even the minimal amount of vegetables and fruit recommended, and junk food consumption is so high.
I second the previous comment. “Modelling” is not evidence. Let’s see real world evidence first — does a tax on sugar actually reduce obesity rates? That is the only evidence that counts.
As a side point, imposing a “sugar tax” will cause food manufacturers to substitute sugar with other sweeteners, e.g. stevia. The long term health implications of stevia (and other additives) are unknown. Of course public health “experts” love to pretend that they are omniscient and infallible, but some caution is warranted. Let’s not repeat the massive public health failures of the past, such as the notorious food pyramid which was based on the flimsiest of evidence.
This debate has been going around and around for far too long. In the meantime, overweight and obesity rates are increasing. Public health advocates need to change tack and get on with their ‘real’ jobs to make a positive difference. Scrap the idea of additional taxes on processed foods. And as for ‘modelling studies’ to underpin an evidence base to guide action. We know what to do: listen to people demonstrating ‘Lived Experience’.