tag:theconversation.com,2011:/africa/topics/sugar-sweetened-beverages-22799/articlessugar sweetened beverages – The Conversation2021-04-20T12:30:44Ztag:theconversation.com,2011:article/1551452021-04-20T12:30:44Z2021-04-20T12:30:44ZHow Rwanda can use fiscal policies to improve health outcomes<figure><img src="https://images.theconversation.com/files/384477/original/file-20210216-17-19uobba.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Rwanda’s health sector has seen many reforms over the past <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60574-2/fulltext?rss=yes">two decades</a>, which have greatly improved public health indicators. Communicable diseases have declined and the <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1581-4">maternal mortality</a> rate fell from 1,071 deaths per 100,000 live births in 2000 to 210 in 2015.</p>
<p>But noncommunicable diseases are a <a href="https://www.who.int/ncds/surveillance/steps/Rwanda_2012_STEPS_Report.pdf">growing problem</a>. Overweight, obesity and associated nutrition related diseases are becoming <a href="https://www.who.int/nmh/countries/rwa_en.pdf?ua=1">more prevalent</a> in Rwanda. </p>
<p>Globally, the rapid increase in consumption of <a href="https://www.who.int/elena/titles/bbc/ssbs_adult_weight/en/">sugar sweetened beverages</a> has been identified as a major contributor to the rise of obesity and noncommunicable disease such as type 2 diabetes. </p>
<p>In several countries taxation on sugar sweetened beverages has <a href="https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1669122">emerged</a> as a cost-effective strategy to combat obesity and noncommunicable diseases. <a href="https://pubmed.ncbi.nlm.nih.gov/29531419/">Research</a> has shown that people buy and consume sugary drinks less when their price is increased through taxation.</p>
<p>Rwanda has an excise tax of <a href="https://taxsummaries.pwc.com/rwanda/corporate/other-taxes#:%7E:text=Excise%20taxes&text=Soda%20and%20lemonade%3A%2039%25.">39%</a> on soft drinks. Its main purpose is to generate revenue. Because it applies to all soft drinks, irrespective of sugar content, the tax as it stands is unlikely to reduce consumption of sugary drinks. </p>
<p>We <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1883911">looked at</a> what might influence the ability of the government to use the soft drinks tax to achieve public health goals.</p>
<p>We found that competing priorities stand in the way of imposing a sugary drinks tax. The government has progressive, cross-sectoral policies to address the growing burden of noncommunicable diseases. But other <a href="https://www.newtimes.co.rw/section/read/51017">policies</a> support the growth of local sugar production and the sugary drinks industry. And the country’s <a href="http://www.rwandafda.gov.rw/web/fileadmin/national_food_and_nutrition_policy_.pdf">food policies</a> generally focus more on food production to make sure people have livelihoods and enough quality food.</p>
<h2>Existing taxes</h2>
<p>The existing excise tax of 39% on soft drinks is well above the 20% tax rate <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">recommended</a> by the World Health Organisation. But it hasn’t had a significant impact on the price or consumption of sugar sweetened drinks compared to non-sugary beverages. This is likely because it applies equally to sugary and non-sugary carbonates. </p>
<p>Still, the tax is a good starting point for policies that put public health first.</p>
<p>The position and economic importance of the sugar sweetened beverage industry in Rwanda is likely to be a barrier to the adoption of such taxation. This has been the case in many <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5">low- and middle-income countries</a>. Concerns about the economic and job implications of a sugary drinks tax may hinder or delay the adoption of such a policy. Opponents of a sugary drinks tax in <a href="https://theconversation.com/how-south-african-food-companies-go-about-shaping-public-health-policy-in-their-favour-143368">South Africa</a> argued that it would result in significant job losses – despite evidence to the contrary. The country increased taxes on sugar-sweetened beverages in 2018. </p>
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<a href="https://theconversation.com/how-south-african-food-companies-go-about-shaping-public-health-policy-in-their-favour-143368">How South African food companies go about shaping public health policy in their favour</a>
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<p>The East African Community can influence markets and companies through trade mechanisms and coordinated regulations. Its secretariat has a <a href="https://ideas.repec.org/p/pot/fiwidp/60.html">technical working group</a> on excise tax coordination. So, interventions at a regional level could be another way of achieving the public health goals. </p>
<p>The policy landscape related to sugary drinks taxation in Rwanda is influenced by many factors and is evolving. The existing policy landscape, at domestic and regional levels, provides opportunities to strengthen sugary drinks taxation. But these are matched by a complex political landscape with competing priorities. Action must be taken to improve support for this intervention and the successful adoption of a policy. </p>
<h2>Recommendations</h2>
<p>We believe the government could use soft drinks tax more effectively as a <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">public health tool</a> without undermining employment and national development. Producers could redesign their production or invest in more healthy products.</p>
<p>It will need the cooperation of government ministries, regulatory authorities, civil society and consumer organisations, as well as academia and research institutions. The East African Community could also play a part by adopting regional regulations. </p>
<p>The role of private actors, such as the beverages industry, in the development of nutrition-related health policies should remain limited to avoid undue influence.</p>
<p>Rwanda should amend the excise tax to target sugar content so that people reduce their consumption of sugary drinks and turn to healthier options. </p>
<p>Different taxes linked to the sugar content of beverages should be adopted such as the ones adopted in countries like Mexico, the United Kingdom and South Africa. These <a href="https://gh.bmj.com/content/4/4/e001317">resulted</a> in increased prices of sugary drinks and encouraged producers to reformulate their products to reduce the sugar content.</p><img src="https://counter.theconversation.com/content/155145/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruhara Mulindabigwi Charles does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rwanda’s food policies focus on production to make sure people have livelihoods and enough nutritious food. Not much attention is given to overnutrition.Ruhara Mulindabigwi Charles, Coordinator of Postgraduate Programmes, School of Economics, University of RwandaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/643902016-08-25T10:25:12Z2016-08-25T10:25:12ZSouth Africans have a sweet tooth so shouldn’t say no to a sugar tax<figure><img src="https://images.theconversation.com/files/135353/original/image-20160824-30222-ylxcud.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Each can of a sugar sweetened beverage has nine teaspoons of sugar. This is more than the recommended daily limit of six. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Debates on a proposed tax for sugar sweetened beverages in South Africa have <a href="http://www.iol.co.za/business/news/sugar-tax-debate-heats-up-2060413">reached fever pitch</a> with the local food and beverage industry squaring up against the proposed sugary drinks tax expected to be implemented in April 2017. Professor Karen Hofman and Aviva Tugendhaft provide a few facts.</em></p>
<p><strong>What difference has a sugar tax made in other countries?</strong></p>
<p>There are many <a href="http://www.who.int/elena/bbc/ssbs_adult_weight/en/">cities and countries</a> that have instituted a sugar tax. These include Mexico, France, Hungary, Chile, Columbia, Brazil, 23 states in the US and the cities of Philadelphia and Berkeley.</p>
<p>The introduction of a sugar tax in Mexico <a href="https://www.insp.mx/epppo/blog/preliminares-bebidas-azucaradas.html">in 2014</a> resulted in a marked difference in consumption patterns. The country is one of the highest consumers of sugary beverages and has one of the <a href="http://www.oecd.org/health/Obesity-Update-2014.pdf">highest obesity</a> rates globally. More than one in three adults were classified as obese. </p>
<p>After the introduction of a 10% tax, the purchase of sugary beverages <a href="https://www.insp.mx/epppo/blog/preliminares-bebidas-azucaradas.html">fell by 12%</a> in the first year. Studies have also shown that since the tax was implemented people have switched to <a href="https://www.insp.mx/epppo/blog/preliminares-bebidas-azucaradas.html">drinking water</a>. </p>
<p><a href="http://www.npr.org/sections/thesalt/2016/08/23/491104093/berkeleys-soda-tax-appears-to-cut-consumption-of-sugary-drinks">New evidence released in Berkeley</a> in the US this year shows that after a sugar tax was introduced in the city sales of sugar sweetened beverages fell by as much as 20% in some areas.</p>
<p>What is important to note is that the introduction of a sugar tax always triggers a much greater level of <a href="https://theconversation.com/when-it-comes-to-sugary-drinks-people-prefer-a-nudge-than-a-tax-58617">awareness</a> about why sugar, particularly liquid sugar, is especially harmful. </p>
<p><strong>Why should there be a sugary beverage tax in South Africa?</strong></p>
<p>It is <a href="http://www.who.int/elena/bbc/ssbs_adult_weight/en/">well established</a> that taxes are the most effective of several ways to reduce the consumption of sugary beverages. This is because taxes reach the entire population and are easily implemented. </p>
<p>South Africa needs one. The country has a massive and growing obesity epidemic. Obesity related lifestyle diseases now rival HIV/AIDS and TB in terms of their impact. About 40% of women and 11% of men suffer from <a href="http://www.hsrc.ac.za/en/research-outputs/view/6493">obesity</a> in the country. And <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370923/">25% of teenage girls</a> in rural South Africa are overweight or obese.</p>
<p>Across the country, research from the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group shows that chronic diseases result in <a href="http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=26124185">one death every hour</a>. Obesity not only shortens a person’s lifespan, it also affects their quality of life. It leads to lifestyle diseases that result in strokes, blindness, amputations and kidney failure. </p>
<p>This health burden is linked to South Africans’ <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1072">daily sugar consumption</a>. According to the <a href="http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1">World Health Organisation</a>, people should not consume more than six teaspoons of sugar a day. Most 330ml fizzy sugary beverages contain <a href="http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/">nine teaspoons of sugar</a> while fruit juices have 10. These sugary drinks have no nutritional value, don’t satisfy hunger and are particularly harmful to the body in liquid form. </p>
<p>An <a href="http://www.cdc.gov/pcd/issues/2015/14_0559.htm">average teenager in Soweto</a> consumes double the recommended daily limit through sugar sweetened beverages. </p>
<p><strong>Business says jobs will be <a href="http://www.iol.co.za/business/news/sugar-tax-plan-sparks-fears-over-jobs-2059949">lost</a>. South Africa’s Health Minister says the consumption of sugar sweetened beverages is having a <a href="http://www.iol.co.za/business/news/sugar-tax-debate-heats-up-2060413">huge impact</a> on the health system. Who is right?</strong> </p>
<p>The cost of sugar consumption to health care and to companies should not be underestimated. </p>
<p>Severe obesity has been linked to a <a href="http://www.samj.org.za/index.php/samj/article/view/7260">23% increase in health care costs</a>.</p>
<p>But the impact on companies must also be viewed through <a href="http://www.iol.co.za/business/news/sugar-tax-plan-sparks-fears-over-jobs-2059949">loss of productivity</a> and absenteeism. <a href="https://www.uschamber.com/report/health-and-the-economy-the-impact-wellness-workforce-productivity-global-markets-0">Projections</a> indicate that obesity will reduce South Africa’s gross domestic product by 7% by 2030. Based on experience with the successful tobacco tax in SA, money spent on cigarettes were spent in other sectors, thus saving lives. </p>
<p>Without any interventions the situation is likely to get worse. Our <a href="http://www.ncbi.nlm.nih.gov/pubmed/26494269">research</a> shows that there will be an additional 1.2 million obese people in the next few years if nothing is done. Of these, almost 300 000 will be obese due to consuming sugar sweetened beverages. </p>
<p>It must also be remembered that job loss figures quoted by companies are based on <a href="http://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/?_r=0">industry commissioned studies</a> which are not peer-reviewed. An evaluation of the impact in Mexico shows no job losses.</p>
<p>The fightback against initiatives to curb sugar consumption has been very aggressive. Reports show that in the US alone <a href="http://www.ibtimes.com/when-soda-taxes-fail-coca-cola-pepsi-spent-100m-against-public-health-initiatives-new-2067433">between 2009 and 2014</a> beverage companies spent US $100 million to sway public and political opinion from initiatives to curb sugar consumption. </p>
<p><strong>Aren’t there better ways to do this, like banning advertising?</strong></p>
<p>There are several other initiatives that can and should take place. Taxing sugar is by far the best prevention focused initiative and is the <a href="http://www.who.int/elena/bbc/ssbs_adult_weight/en/">first of several steps</a>. Food advertising regulations are the next best way to curb the consumption of sugar sweetened beverages, alongside front of pack labelling and work site and school based interventions. </p>
<p>In South Africa there is a <a href="https://www.ifballiance.org/sites/default/files/South_african_marketing_to_children_pledge.pdf">voluntary marketing pledge</a> under which the food and beverage industry has promised not to advertise unhealthy products to children under the age of 12. But this is ignored.
A recent <a href="http://www.cdc.gov/pcd/issues/2015/14_0559.htm">study in Soweto</a>, considered one of the biggest urban settlements in Africa, showed billboards advertising sugar sweetened beverages close to schools in the area. </p>
<p>Taxing sugar sweetened beverages should be done in conjunction with awareness initiatives as well as mandatory advertising regulations and front of pack labelling.</p><img src="https://counter.theconversation.com/content/64390/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Hofman currently receives research funding from the South African Medical Research Council and The Bill and Melinda Gates Foundation. In the past she has also received funding from the IDRC (Canada), the WHO and UNFPA. She is a member of the board of directors of The Soul City Institute for Health and Development Communication.</span></em></p><p class="fine-print"><em><span>Aviva Tugendhaft receives funding from the Bill and Melinda Gates Foundation and the SA medical research council</span></em></p>South Africa’s massive and growing obesity epidemic has much to do with people’s excessive daily sugar intake.Karen Hofman, Program Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, University of the WitwatersrandAviva Tugendhaft, Deputy Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, Wits School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/564392016-04-13T20:18:38Z2016-04-13T20:18:38ZAustralian sugary drinks tax could prevent thousands of heart attacks and strokes and save 1,600 lives<figure><img src="https://images.theconversation.com/files/118448/original/image-20160413-15868-7jt922.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sugary drinks are high in energy and lead to weight gain and obesity.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/tokyoexpressway/8192427826/">Justin C./Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Last month the <a href="http://www.telegraph.co.uk/food-and-drink/news/sugar-tax-what-does-it-mean-and-who-will-be-affected/">United Kingdom</a> announced a sugar tax on soft drinks. The tax will come into effect in 2018, with the funds to be used to address childhood obesity.</p>
<p>The move has been <a href="http://www.sbs.com.au/news/article/2016/03/17/health-campaigners-delighted-uk-sugar-tax-surprise">applauded</a> by public health groups internationally. Unsurprisingly, the tax is <a href="http://www.fooddrinktax.eu/">strongly opposed</a> by powerful groups in the food industry, and the announcement resulted in <a href="http://www.dailymail.co.uk/news/article-3495805/Coca-Cola-Pepsi-Dr-Pepper-shares-sent-plummeting-UK-announced-tax-soft-drinks-combat-child-obesity.html">shares in Coca-Cola temporarily plunging</a>. </p>
<p>In our new research <a href="http://dx.plos.org/10.1371/journal.pone.0151460">published today in PLOS ONE</a>, for the first time we have modelled the impact of such a tax in Australia. Over 25 years, a 20% rise in the price of soft drinks and flavoured mineral waters would save 1,600 lives. It would also prevent 4,400 heart attacks and 1,100 strokes.</p>
<p>Overall, the savings to the health-care system would add up to A$609 million.</p>
<p>It’s time for Australia to follow the UK’s lead and increase the price of sugary drinks. </p>
<h2>What’s wrong with sugary drinks?</h2>
<p>The evidence of the negative health impact of these products is clear, particularly with respect to <a href="http://www.rethinksugarydrink.org.au/facts/tooth-decay.html">dental health</a>. Sugary drinks are also associated with increased energy intake and, in turn, weight gain and <a href="http://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/">obesity</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/118455/original/image-20160413-15853-10t9ij6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/118455/original/image-20160413-15853-10t9ij6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118455/original/image-20160413-15853-10t9ij6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118455/original/image-20160413-15853-10t9ij6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118455/original/image-20160413-15853-10t9ij6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118455/original/image-20160413-15853-10t9ij6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118455/original/image-20160413-15853-10t9ij6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sugary drinks are particularly popular among adolescents.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/doobybrain/355919755/">Herman Yung/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>Obesity is a <a href="http://www.ncbi.nlm.nih.gov/pubmed/22412070">leading risk factor</a> for type 2 diabetes, heart disease and some cancers. </p>
<p>Soft drinks are very popular, particularly among children and adolescents. So there is much to be gained, from a population health perspective, from limiting their consumption.</p>
<p><a href="http://www.wcrf.org/int/policy/nourishing-framework/use-economic-tools">Many countries</a> have already recognised the potential to improve population health by taxing sugary drinks. In recent years, Hungary, Mexico, France and Chile have all implemented a tax. The UK announcement follows a similar one by <a href="http://mg.co.za/article/2016-02-24-budget-speech-2016-gordhan-introduces-sugar-tax">South Africa</a> earlier in 2016. </p>
<h2>Potential impact in Australia</h2>
<p>Our <a href="http://dx.plos.org/10.1371/journal.pone.0151460">PLOS ONE</a> research examined the potential impact of a 20% rise in the prices of sugar-sweetened carbonated soft drinks and flavoured mineral waters on health, health-care expenditure and potential revenue. </p>
<p>As expected, the tax would result in people decreasing their consumption of sugary drinks. The influence of a price increase would be greatest on those who drink a lot of sugary drinks, so the greatest impact would be on younger age groups. This is an important result that is difficult to achieve through other obesity-prevention measures.</p>
<p>The decreases in consumption would result in small declines in the prevalence of obesity of about 0.7% in men and 0.3% in women.</p>
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<img alt="" src="https://images.theconversation.com/files/118452/original/image-20160413-15880-bpv01t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/118452/original/image-20160413-15880-bpv01t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118452/original/image-20160413-15880-bpv01t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118452/original/image-20160413-15880-bpv01t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118452/original/image-20160413-15880-bpv01t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118452/original/image-20160413-15880-bpv01t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118452/original/image-20160413-15880-bpv01t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Younger age groups would be most impacted by a tax.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/andreasmb/173480639/">Andreas Brændhaugen/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
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<p>When the health benefits of these changes are modelled for the whole population over their lifetime, the influence of the tax is substantial. The research estimates that it would reduce the number of new type 2 diabetes cases by approximately 800 per year. </p>
<p>Twenty five years after the introduction of the tax, there would be 4,400 fewer cases of heart disease and 1,100 fewer strokes. An estimated 1,600 people would be alive as a result of the tax. Overall, the savings to the health-care system would add up to A$609 million.</p>
<p>Even taking into account declines in consumption, the revenue collected from the tax would be more than A$400m annually. This would provide the government with a significant pool of funds to subsidise healthy food for low-income Australians, contribute to childhood obesity-prevention programs and support the promotion of healthy eating. </p>
<p>If other beverages with added sugar not included in this study (such as energy drinks, fruit drinks, milk-based drinks and cordials) were also taxed, the revenue and health benefits would be even greater.</p>
<h2>High sugary drink consumption in Australia</h2>
<p>The World Health Organisation (WHO) recently released revised guidelines for sugars, recommending that energy from “free sugar” (added by manufacturers, cooks or the consumer) is limited to less than 10% overall. </p>
<p>A recent <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10189703&fileId=S0007114515005255">analysis</a> of added sugar in the Australian population found that most adults and children exceed the WHO recommendation, with sugary drinks accounting for the largest proportion of added sugar.</p>
<p>Just looking at supermarket retail sales, <a href="https://retailmedia.com.au/product/retail-world-2014-annual-report-international-shipping/">Australians bought around</a> 1.1 billion litres of sugary drinks in 2015 at a cost of A$2.2 billion. This doesn’t include what is bought from fast-food outlets, cinemas, vending machines, hotels and convenience stores.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/118453/original/image-20160413-15868-1vd4778.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/118453/original/image-20160413-15868-1vd4778.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118453/original/image-20160413-15868-1vd4778.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118453/original/image-20160413-15868-1vd4778.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118453/original/image-20160413-15868-1vd4778.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118453/original/image-20160413-15868-1vd4778.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118453/original/image-20160413-15868-1vd4778.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most Australians exceed the recommended maximum levels of sugar.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dno1967b/7390223200/">Daniel Oines/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In many remote Indigenous communities, sugary drink consumption is particularly high. <a href="http://www.abc.net.au/news/2016-02-12/scullion-says-sugar-is-killing-remote-communities/7162974">Evidence to Senate Estimates</a> revealed that, in the last financial year, remote Indigenous communities were buying 1.1 million litres of sugary soft drink through community stores. This elicited a <a href="http://www.abc.net.au/news/2016-02-12/scullion-says-sugar-is-killing-remote-communities/7162974">response</a> from Indigenous Affairs Minister Nigel Scullion who said:</p>
<blockquote>
<p>I think in remote communities and very remote communities, sugar is just killing the population.</p>
</blockquote>
<h2>Strong public support</h2>
<p>The sugary drinks industry, represented by the Australian Beverages Council, has <a href="http://australianbeverages.org/soft-drink-tax-exercise-futility/">widely criticised</a> a tax on sugary drinks. </p>
<p>But the majority of Australians support such a tax. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/23088483">survey in 2012</a> showed that two-thirds (65%) of respondents were in favour of a tax on soft drinks if the money was used to reduce the cost of healthy food. </p>
<p>This strong public support, together with the substantial health benefits and extra revenue that could be expected from the tax, should make it a highly attractive policy option for the Australian government. </p>
<p>At a time when the cost of preventable disease is threatening to overwhelm the health system, a tax on sugary drinks is an essential element of a comprehensive approach to address poor diets and overweight and obesity.</p><img src="https://counter.theconversation.com/content/56439/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Sacks receives funding from the Australian National Health and Medical Research Council (NHMRC) and the Australian Research Council (ARC).</span></em></p><p class="fine-print"><em><span>Jane Martin is Executive Manager of the Obesity Policy Coalition and is employed by the Cancer Council Victoria which provided funding to University of Queensland to undertake the modelling in the study. </span></em></p><p class="fine-print"><em><span>Lennert Veerman receives funding from the National Health and Medical Research Council (NHMRC).</span></em></p>It’s time for Australia to follow the UK’s lead and increase the price of sugary drinks.Gary Sacks, Senior Research Fellow, WHO Collaborating Centre for Obesity Prevention, Deakin UniversityJane Martin, Executive Manager of the Obesity Policy Coalition; Senior Fellow, Faculty of Medicine, Dentistry and Health Sciences, The University of MelbourneLennert Veerman, Senior Research Fellow, School of Population Health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/566962016-03-22T11:51:13Z2016-03-22T11:51:13ZWhat the world can learn from Mexico’s tax on sugar-sweetened drinks<figure><img src="https://images.theconversation.com/files/115997/original/image-20160322-32309-zo96kr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The beverage industry provided shops in Mexico with free fridges.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=X7rdvbrKpAGhtOy_wkqSTQ-1-5&clicksrc=download_btn_inline&id=193574402&size=medium_jpg&submit_jpg=">Takamex/Shutterstock.com</a></span></figcaption></figure><p>One of the main talking points from the recent UK Budget, was the announcement of a tax on sugary soft drinks. But Mexico already has a sugar tax. So what do we know about its impact? And what can Britain learn from it? </p>
<p>As with Mexico, Britain has been struggling with a very fat problem. The difference is that Mexico dared to take the first step towards taxing sugary drinks. The journey has been turbulent, but recent research seems to show that <a href="http://www.bmj.com/content/352/bmj.h6704.long">progress has been made</a>.</p>
<p>Mexico is a country where the sugar-sweetened beverage industry has penetrated and <a href="http://www.scielo.org.ve/scielo.php?script=sci_arttext&pid=S0004-06222014000400002">changed</a> the core of Mexican culture. Cherished for its rich nutritional value, the traditional Mexican diet is composed of abundant fruit and vegetables, whole grains, pulses and spices.</p>
<p>The everyday bread in Mexico has always been the tortilla. Traditionally produced from corn grown in “milpas” – an environmentally sustainable agricultural system in which corn, beans and squash grow symbiotically – the tortilla now has a great rival: fizzy drinks.</p>
<p>From being a healthy country, today 71% of Mexico’s adult population is <a href="http://ensanut.insp.mx/informes/ENSANUT2012ResultadosNacionales.pdf">overweight or obese</a>. What’s more, sugary drinks contribute <a href="http://www.insp.mx/epppo/blog/3609-consumo-azucar-mexico-nueva-directriz-oms.html">70%</a> of the added sugar in the <a href="http://jn.nutrition.org/content/144/6/949.long">Mexican diet</a>. In 2012, an average Mexican drank <a href="http://ensanut.insp.mx/informes/ENSANUT2012ResultadosNacionales.pdf">163 litres</a> of sugar-sweetened drinks a year.</p>
<h2>A nation’s diet transformed</h2>
<p>The <a href="http://www.theglobalbrandonline.com/brand-success/brands-grow-over-time/coca-cola/">beverage industry</a> entered Mexico and conquered its population by providing free refrigerators to restaurants, taco joints and family run corner stores. Available even in the most remote parts of Mexico, fizzy drinks transformed the diet and the health of the nation.</p>
<p>Faced with overwhelming obesity rates, in January 2014 Mexico became one of the first countries in the world to impose a <a href="http://www.jhsph.edu/departments/health-behavior-and-society/_pdf/Advocating_For_Sugar_Sweetened_Beverage_Taxation.pdf">tax on sugary drinks</a>. The tax was imposed on any beverages with added powder, syrup, flavour extract, sugar or caloric sweeteners. Fizzy drinks, energy drinks, bottled tea and coffee, fruit juice and any fruit-flavoured drink with added sugar were all taxed at the rate of one Mexican peso (about £0.04) per litre.</p>
<p>The world has had Mexico under observation since. And in January 2016, the Instituto Nacional de Salud Pública in Mexico and the University of North Carolina published in the <a href="http://www.bmj.com/content/352/bmj.h6704">BMJ</a> their first analysis of the effects of the sugar tax there. The results looked promising.</p>
<h2>What the BMJ report revealed</h2>
<p>On average, a 6% drop in sugary drink purchases was achieved in 2014. By the end of 2014, a 12% fall had occurred. Among the poorest households, the annual average sale of sugary drinks dropped by 9% and by December 2014, sales had decreased by 17%. Sales of bottled water and beverages with no added sugar increased by 4%.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/115825/original/image-20160321-30935-1neahfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/115825/original/image-20160321-30935-1neahfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115825/original/image-20160321-30935-1neahfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115825/original/image-20160321-30935-1neahfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115825/original/image-20160321-30935-1neahfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115825/original/image-20160321-30935-1neahfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115825/original/image-20160321-30935-1neahfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People are buying more of this stuff.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=tK3Z-bgsN-tVKTmUUCGJnA-1-0&clicksrc=download_btn_inline&id=273855272&size=medium_jpg&submit_jpg=">www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>In 2015, annual sales decreased from 163 litres to 137 litres per capita. The estimated revenue from a 10% tax on sugary drinks is 15.4-16.0 billion pesos (about £639m). It has been estimated that the reduction in sugary drink consumption will reduce the number of people who are overweight or obese by 1% (this estimate is based on a baseline of 163 litres intake per person).</p>
<p>The industry says that by taxing food, poor people will be affected. This is true. The recent research in Mexico points to a greater decrease in sugary drink purchase in poor communities, which is to be welcomed. Although obesity is currently more common among the more affluent in society, poorer people generally have worse health and less access to healthcare, as well as lower disposable income.</p>
<p>Although it’s too early to know if overall sugar consumption has gone down, the results so far show that the tax could potentially reduce inequalities if it improves health behaviours among poorer communities and encourages spending on healthier – or less unhealthy – products. It may even prevent the shift that has been seen in most countries, where the highest obesity prevalence flips from the more affluent to the poorer sectors of society. Spending less on fizzy drinks could mean better health and more money.</p>
<h2>Only the beginning</h2>
<p>If the UK and other countries want to reduce the prevalence of metabolic diseases, governments need the tax to be about health and not money. A negative aspect of the sugary beverage tax in Mexico is that the revenue raised is not being directed to the prevention of obesity. So where is it going?</p>
<p>Since the <a href="http://www.naftanow.org/">North American Free Trade Agreement</a> (NAFTA) in 1994, the availability of fizzy drinks and junk food in convenience stores and other food outlets in Mexico has increased dramatically. My current research studies the association of the density and proximity of the different types of food outlets (the food environment) and obesity in Mexico. Could the strategic presence of food outlets be triggering fizzy drinks intake and metabolic disease in Mexico?</p>
<p>The world economy favours the accessibility of cheap and highly processed foodstuffs that have little or no nutritional content (sugary drinks being the best example). Tackling metabolic disease needs an integrated approach and the sugar tax is only the beginning. Greater efforts are required to restructure the food environment, increasing the availability of healthy foods and making the healthy option the easy option.</p><img src="https://counter.theconversation.com/content/56696/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elisa Pineda receives funding from the National Council of Science and Technology (Conacyt) in Mexico for her PhD studies. </span></em></p>All eyes have been on Mexico since they imposed a tax on sugary drinks – and now the data is in.Elisa Pineda, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/504242015-11-24T04:29:35Z2015-11-24T04:29:35ZObesity: why South Africans need to can soft drinks<figure><img src="https://images.theconversation.com/files/102806/original/image-20151123-18246-1tljisr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africans need to reduce the number of sugar-sweetened beverages they consume.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>If South Africans don’t drastically reduce the number of cool drinks, juices and sugar-sweetened beverages they drink every day, there will be more than nine million obese adults in the country by 2017. </p>
<p>Just three years ago, the country hit the mark of <a href="http://journals.cambridge.org/download.php?file=%2FPHN%2FS1368980015003006a.pdf&code=46bcad3ccceb70d8e4a6c55bf429b91c">eight million</a> obese people, making it the most obese nation on the continent and joining the likes of global heavyweights such as Mexico and the US.</p>
<p>The 2017 projection, captured in our <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10012163&fileId=S1368980015003006">study</a>, means there will be 1.2 million more obese adults in South Africa. And more than one-quarter of these people will be obese because of the sugar sweetened beverages they drank. </p>
<p>These drinks are not the only reason for the increase in obesity. But because they are high in sugar and contain no essential nutrients, they are a significant contributor. For adults, drinking just one of these beverages a day increases the likelihood of being overweight by almost <a href="http://healthpolicy.ucla.edu/publications/Documents/PDF/stillbubbling-healthimplications-oct2013.pdf">30%</a>. </p>
<p>For children, this risk increases to more than 50%. Other factors that contribute to obesity and overweight are eating fast food or processed food on a regular basis and not exercising.</p>
<p>Across the country, sugar-sweetened beverages result in <a href="http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=26124185">one death every hour</a>.
Lifestyle diseases related to obesity, which can result in stroke, blindness, amputations and kidney failure, not only shorten one’s lifespan but also affect their quality of life. These deaths and disabilities place a major financial strain on families and on the already overburdened healthcare system.</p>
<p>If preventive measures are not introduced it is highly likely that people will drink more and more sugar-sweetened drinks over the next few years. </p>
<h2>Tackling the fat problem</h2>
<p>The South African National Department of Health has set a target of reducing the number of people who are obese or overweight by 10% <a href="http://www.hsrc.ac.za/uploads/pageContent/3893/NCDs%20STRAT%20PLAN%20%20CONTENT%208%20april%20proof.pdf">by 2020</a>. Its strategic plan for non-communicable diseases identifies several cost-effective preventive interventions to achieve this.</p>
<p>One of these is a tax on unhealthy products like a sugar tax. This would mean that the <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105287">cost</a> of cool drinks would increase, making them less affordable.</p>
<p>But in addition to a sugar-sweetened beverage tax, a complete package of interventions is needed for the greatest impact on obesity reduction. Other measures include:</p>
<ul>
<li><p>food advertising regulations; </p></li>
<li><p>easy to understand food labelling; and </p></li>
<li><p>work site and school based interventions. </p></li>
</ul>
<p>The government could also subsidise healthy products. Ideally this should be accompanied by strong education campaigns about the dangers of excessive sugar consumption.</p>
<p>Although the national strategic plan acknowledges the need for a set of interventions including a sugar tax, specific regulations have not yet been passed. </p>
<p>But lessons can be learned from Mexico – one of the most <a href="http://www.oecd.org/health/Obesity-Update-2014.pdf">obese countries</a> on the planet.</p>
<p>For almost a decade, the Mexican soft drink industry spent millions blocking efforts to reduce soda <a href="http://www.theguardian.com/news/2015/nov/03/obese-soda-sugar-tax-mexico">consumption</a>. But impressive public health campaigns and demands for interventions led to a National Prevention and Control Strategy in 2013 and the implementation of a soda tax in January 2014. </p>
<p>By 2015, soda sales had decreased by 10% and people were drinking more <a href="http://www.insp.mx/epppo/blog/preliminares-bebidas-azucaradas.html">water</a>. </p>
<h2>Consumers have little choice</h2>
<p>There is an overwhelming perception that if consumers are educated, they will make good choices. But currently food and beverage choices are shaped by availability, affordability and most importantly relentless marketing. The food and advertising environment in South Africa makes it increasingly difficult to make healthy choices. </p>
<p>Currently, higher-income groups drink more sugar-sweetened beverages. But this is likely to change as the industry has started to target lower-income groups, who are more <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10012163&fileId=S1368980015003006">vulnerable</a>. </p>
<p>The largest soft drink bottler in the country is clear about its intentions to <a href="http://www.sabmiller.com/docs/default-source/investor-documents/presentations/2014/quarterly-divisional-seminar-south-africa-2014.pdf">aggressively grow</a> its reach within the poorest sector of the population. The growth strategy will be driven by marketing and advertising to connect particular brands with aspirations and passions. This will place an already vulnerable population at even greater risk for obesity-related diseases, and will be exacerbated by existing poor access to quality disease screening and health care. </p>
<p>The impact on children is even worse. One <a href="http://www.cdc.gov/pcd/issues/2015/14_0559.htm">study</a> shows that although many of the leading brands in the country have committed to marketing that promotes healthy choices for <a href="https://www.ifballiance.org/sites/default/files/South_african_marketing_to_children_pledge.pdf">children</a>, half of the sugar-sweetened beverage billboard advertising in Soweto is deliberately close to schools with nearby vendors providing convenient access. </p>
<p>In both the formal and informal convenience stores, locally known as spaza shops, these products are also strategically placed to ensure the most profitable and high-sugar ones are at eye level and easily accessible.</p>
<h2>Levelling the playing field</h2>
<p>Consumers are persuaded to make unhealthy choices through the use of tactical marketing techniques and strategic placement and availability of unhealthy products. </p>
<p>The playing field needs to be levelled with interventions that nudge people to make healthier choices. In the absence of such measures, South Africa is headed towards a future with unprecedented rising healthcare costs, and deaths and disabilities from obesity-related diseases.</p><img src="https://counter.theconversation.com/content/50424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aviva Tugendhaft receives funding from the Bill and Melinda Gates Foundation and the SA medical research council</span></em></p><p class="fine-print"><em><span>Karen Hofman receives funding from the Bill and Melinda Gates Foundation, SA medical research council. </span></em></p>With one can of cool drink containing six teaspoons of sugar – your recommended sugar intake for the day – there is a need to reduce the number of sugar-sweetened beverages South Africans consume.Aviva Tugendhaft, Deputy Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, Wits School of Public Health, University of the WitwatersrandKaren Hofman, Program Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.