tag:theconversation.com,2011:/id/topics/sugar-tax-22096/articlesSugar tax – The Conversation2024-03-28T12:18:54Ztag:theconversation.com,2011:article/2232392024-03-28T12:18:54Z2024-03-28T12:18:54ZWhat is sugar and what would happen if I stopped eating it? A scientist explains<p>The world has declared a time-out on sugar consumption. The harmful link between disease and dietary sugar was recently outlined in a <a href="https://pubmed.ncbi.nlm.nih.gov/37019448/">comprehensive assessment</a> of published studies. </p>
<p>Recognising this link between widely consumed food and disease is essential in marshalling forces to <a href="https://www.who.int/tools/elena/interventions/free-sugars-adults-ncds">change harmful outcomes</a>. These include coronary heart disease, obesity, type 2 diabetes, tooth decay and some cancers. For over a decade, <a href="https://www.researchgate.net/profile/Grace-Jones-10#publications">my research</a> has focused on the mechanisms by which fructose intake plays into disease. </p>
<p>A growing number of African countries have joined the worldwide efforts to reduce sugar intake. For instance, in an attempt to address obesity, diabetes and other non-communicable diseases, South Africa introduced a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9597050/#:%7E:text=South%20Africa%20became%20the%20first,implemented%20on%201%20April%202018.&text=Referred%20to%20as%20the%20Health,billions%20of%20rands%20in%20revenues.">tax on sugar-sweetened drinks</a> in 2018. </p>
<p>It’s hard to avoid sugar when it’s become a normal part of diets and when we celebrate special times with sweet treats. But being more aware of what sugar is and how it can affect our health is the first step.</p>
<h2>What is sugar?</h2>
<p>Sugar is a class of naturally occurring sweet-tasting molecules found in fruits, vegetables, plants and the milk of mammals. It can be extracted from these natural sources and concentrated in processed foods. </p>
<p>The sweet-tasting molecules in sucrose (table sugar) are glucose and fructose. </p>
<p>Sucrose is a disaccharide. This is a molecule made of two simple sugars – glucose and fructose – in a 1:1 ratio and chemically bound. Sucrose is used in many processed foods.</p>
<p>High fructose corn syrup, also used in processed foods, is a mixture of the monosaccharides glucose and fructose. Usually the combination is 45% glucose and 55% fructose. </p>
<p>Sucrose and high fructose corn syrup are more concentrated in processed foods than in fruits and vegetables. </p>
<p>Both are considered added sugars when they are <a href="https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/1541-4337.12151">added to foods and drinks</a>. Besides the sweet taste, they may be <a href="https://www.sciencedaily.com/releases/2015/08/150818131807.htm#:%7E:text=Sugar%20aids%20in%20the%20fermentation,reducing%20water%20activity%20in%20foods">added</a> for colour and texture, as a preservative or to aid fermentation. </p>
<p>There are other natural sugars found in the foods we eat. Lactose, or milk sugar, is a disaccharide made of two simple sugars – glucose and galactose – in a 1:1 ratio. It’s found in mammals’ milk and produced naturally to provide nutrition to offspring, and in other dairy products, such as cheese and ice cream. </p>
<p>Honey, made from nectar by honeybees, is primarily a mixture of glucose and fructose monosaccharides with some maltose, sucrose and other carbohydrates. Maltose, which is found in breakfast cereals and breads, is a disaccharide of two glucose molecules. </p>
<p>Naturally occurring sugars are made by plants, bees or mammals based on their needs. </p>
<p>The human body needs glucose as a fuel for every cell, especially brain cells. That’s one of the reasons why we need a stable blood glucose level throughout the day and night.</p>
<p>The way our bodies use fructose is different. It can be turned into glucose, used as fuel, or processed into fats, called triglycerides. Excessive fructose in our diets can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29408694/">increases</a> in blood triglycerides, liver fat, blood glucose, body mass index and insulin resistance (where the body cannot easily remove glucose from the bloodstream). </p>
<p>Increases in these markers can lead to an increased risk for metabolic dysfunction, type 2 diabetes and non-alcoholic fatty liver disease (or metabolic dysfunction-associated steatotic liver disease). </p>
<p>Because of the difference in how the body uses glucose and fructose, and evidence that a higher consumption of sugar leads to worse health outcomes, we must be mindful of the added sugar we eat.</p>
<h2>What would happen if we quit eating sugar?</h2>
<p>A group of scientists performed a study and published a set of research papers that detailed <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21371">exactly what happened</a> when over 40 children (aged eight to 18) stopped eating sugar and fructose for 10 days. The participants didn’t stop eating bread, hotdogs or snacks. They stopped eating fructose. These studies found <a href="https://pubmed.ncbi.nlm.nih.gov/28579536/">significant reductions</a> in:</p>
<ul>
<li><p>newly made triglycerides (or fats)</p></li>
<li><p>fasting blood glucose</p></li>
<li><p>blood pressure</p></li>
<li><p>fat stored on organs, including the liver</p></li>
<li><p>AST, which is a marker of liver function</p></li>
<li><p>insulin resistance, as their cells were better able to remove glucose from the bloodstream</p></li>
<li><p>body mass index.</p></li>
</ul>
<p>The participants also reported feeling better and were better behaved.</p>
<p>The World Health Organization has made <a href="https://iris.who.int/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1">recommendations</a> for adults and children to reduce their sugar intake to about 58 grams, or 14 teaspoons, per day or between 5% and 10% of total caloric intake. </p>
<p>This is not a lot of sugar. </p>
<p>Consider that a 300ml bottle of Coca-Cola or 240ml cup of sugarcane juice contain about <a href="https://www.coca-cola.com/ke/en/brands/brand-coca-cola/product-coca-cola-original#accordion-d588759a1d-item-8b5bb499cf">30 grams</a> of sugar. One piece of mandazi, a popular deep-fried Kenyan wheat snack, has about <a href="https://www.nutritionix.com/i/nutritionix/mandazi-1-small-piece-3-diameter/5c4f552f21b2c9e80f1748f2">4 grams</a> of sugar, or about 6% of the WHO’s recommended intake contained in each small piece.</p>
<h2>What can I do to lower my sugar intake to recommended levels?</h2>
<p>First, keep track of everything you eat during a typical day, what you eat, when you eat and how much you eat. Secondly, give yourself a star for the fresh vegetables and whole fruits you eat, and identify the foods that have added sugars. </p>
<p>Now, set an attainable goal that details one thing you can change to either:</p>
<p>1) increase the whole fruits or vegetables you eat or </p>
<p>2) decrease the amount of added sugar that you eat each day. </p>
<p>This way, you can be mindful of the added sugar you consume and adjust what you eat accordingly.</p><img src="https://counter.theconversation.com/content/223239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grace Marie Jones receives funding from The National Institutes of Health (US). </span></em></p>A higher consumption of sugar leads to worse health outcomes, so we need to be mindful of the added sugar we eat.Grace Marie Jones, Associate Professor, College of Osteopathic Medicine, Touro UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2232132024-02-28T13:11:58Z2024-02-28T13:11:58ZAre slushies really bad for young children’s health?<p>Recently there have been concerning reports <a href="https://www.thescottishsun.co.uk/health/11883723/parents-risks-expert-slushie-kid-collapse/">in the news</a> of a three-year-old boy who collapsed and was admitted to hospital after drinking a slushy drink. Fortunately, after a few days, the child recovered completely. </p>
<p>This has led to calls for improved labelling where slushies are sold so that parents are better educated about the potential risks to young children consuming these drinks. It has also led to calls for the drinks to be removed from sale at certain venues, such as soft-play centres. </p>
<p>This follows from reports of <a href="https://www.food.gov.uk/news-alerts/news/not-suitable-for-under-4s-new-industry-guidance-issued-on-glycerol-in-slush-ice-drinks">three other young children</a> being admitted to hospital following consuming slushy drinks containing glycerol, which in 2023 led to the Food Standards Agency in the UK reviewing the safety of glycerol in slushies. These children had low blood glucose and high levels of glycerol before recovering. </p>
<p>This led to the recommendation that slushy drinks containing glycerol should not be offered to children aged <a href="https://www.food.gov.uk/news-alerts/news/not-suitable-for-under-4s-new-industry-guidance-issued-on-glycerol-in-slush-ice-drinks">four years and younger</a>.</p>
<p>Using these figures it was also recommended that children under ten should not be offered free refills. This advice also includes the recommendation that these customers should be informed of these <a href="https://www.foodstandards.gov.scot/publications-and-research/publications/industry-guidelines-for-the-food-additive-glycerol-e-422-in-slush-ice-drinks">risks and restrictions</a> for young children, but no recommendations were made about restricting where they could be sold.</p>
<h2>What is glycerol?</h2>
<p>Glycerol also known as glycerine <a href="https://www.food.gov.uk/business-guidance/approved-additives-and-e-numbers#:%7E:text=Glycerol%20E%20422">or E422</a> is recognised as being <a href="https://www.fda.gov/files/food/published/GRAS-Notice-000583---Esterified-propoxylated-glycerol.pdf">generally safe as a food additive</a> by the EU and the US Food and Drug Administration. Chemically, it is described as a <a href="https://foodinsight.org/what-is-glycerin/#:%7E:text=Highlights,vinegar%2C%20wine%20and%20wine%20vinegar.">sugar alcohol</a>. </p>
<p>Aside from slushies, glycerol is also found in flavourings such as vanilla essence and is often used to keep icing soft.</p>
<p>Normally, in our bodies, glycerol is connected to fatty acids, so levels in the blood are low. Also, our bodies do not have a way of regulating or controlling glycerol in the same way we produce insulin to control glucose (blood sugar). So there is no way for our body to simply start using more glycerol in cells in the way we can with glucose after a meal. </p>
<p>This does not mean glycerol is toxic, it just means it can stay in blood for longer than glucose. As this adds to the amount of things dissolved in our blood, it means the plasma in blood becomes more concentrated and can draw water from other parts of the body, including the brain, which can lead to symptoms such as headache, nausea and dizziness.</p>
<figure class="align-center ">
<img alt="Two girls share a slushy" src="https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is no way for our body to use more glycerol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-cute-little-sisters-drinking-colorful-530498500">MNStudio/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why use glycerol in slushies?</h2>
<p>How slushies are made has changed, at least partly in response to a UK government policy on sugar reduction and the <a href="https://www.gov.uk/money/soft-drinks-industry-levy">Soft Drinks Industry Levy</a> (the “sugar tax”). Where most sweetened soft drinks, were able to use a mix of low- and no-calorie sweeteners – such as aspartame – this doesn’t work when it comes to slushies.</p>
<p>The challenge when making slushies, compared to normal soft drinks, is the sugar does more than provide sweetness. Sugar has the physical function in slushies of decreasing the freezing point of water. Water freezes at 0°C, but adding sugar reduces the ability of the water molecules to connect by hydrogen bonds and form ice. </p>
<p>Adding sugar to water and churning as the temperature drops below zero produces slush rather than ice. To do this, you need at least 12g of sugar per 100ml, which would mean sugar-containing slushies would be liable for the highest rate of <a href="https://www.gov.uk/government/statistics/soft-drinks-industry-levy-statistics/soft-drinks-industry-levy-statistics-commentary-2021#:%7E:text=Soft%20Drinks%20Industry%20Levy%20net%20liabilities,-SDIL%20rates&text=In%20April%202023%2C%20SDIL%20was,rate%20(24p%20per%20litre).">tax at 24p per litre</a> in the UK. </p>
<p>In line with <a href="https://www.gov.uk/government/collections/sugar-reduction">sugar reduction strategies</a>, aimed at helping people consume the target set by the government’s <a href="https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report">Scientific Advisory Committee on Nutrition</a> of less than 5% of energy from added sugar, manufacturers have looked for another solution.</p>
<p>In a slushy, intense sweeteners, such as aspartame, won’t work as it is a very intense sweetener <a href="https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report">being 200 times sweeter</a> than sugar. So you can’t just swap out sugars for aspartame. A different solution is needed, one where a similar quantity of sweetener is used compared with sugar. These so-called bulk sweeteners, such as sorbitol and mannitol, can have a laxative effect, so they aren’t great options. </p>
<p>Glycerol was the chosen solution, which can make a slushy with around 5g per 100ml. But is that amount safe to consume?</p>
<p>European Food Safety Agency reassessed the <a href="https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2017.4720">safety of glycerol</a> in 2017. It reported that consuming 125mg per kilogram of body weight per hour was enough to increase the concentration of blood and potentially cause symptoms in patients. This was based on how glycerol was used in the past to treat swelling in the brain (cerebral oedema). However, there is little data on the effect of glycerol outside of hospitals, and it was assumed that this level of intake could be linked to potential risks. </p>
<p>For an adult, there are no risks of drinking an average-sized slushy, simply because they are bigger and unlikely to achieve a blood level high enough to bring on symptoms. But for a young child, because of their size, it was considered that the risk was deemed high enough for warnings to be issued.</p>
<p>However, the Food Standards Agency’s response and recommendations to restrict the supply of slushies to young children could benefit from being more clearly communicated and more effectively applied.</p><img src="https://counter.theconversation.com/content/223213/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duane Mellor consulted with Frozen Brothers as part of the Food Standards Agency work on the safety of glycerol as a sweetener in slush drinks</span></em></p>The Food Standards Agency advises that children under four should not be given these drinks.Duane Mellor, Lead for Evidence-Based Medicine and Nutrition, Aston Medical School, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2164562023-10-30T16:15:23Z2023-10-30T16:15:23ZDiabetes is South Africa’s second biggest killer disease: hiking the sugar tax would help<p><a href="https://www.macrotrends.net/countries/ZAF/south-africa/death-rate">Death rates in South Africa</a> have declined slightly during the past few years. But the country faces a steady rise in both death and disability caused by <a href="https://www.statssa.gov.za/?p=16729#:%7E:text=In%20South%20Africa%2C%20deaths%20due,males%20and%2069%20for%20females.">increases</a> in non-communicable diseases such as diabetes and cancer.</p>
<p>According to the <a href="https://ncdalliance.org/">NCD Alliance</a>, a civil society network, non-communicable diseases <a href="https://ncdalliance.org/why-ncds/NCDs">cause 71% of deaths</a> globally. Of these deaths <a href="https://www.afro.who.int/countries/south-africa/publication/acting-against-non-communicable-diseases-south-africa-investing-healthier-future">85% occur in low and middle income countries</a>. </p>
<p>In South Africa, according to <a href="https://www.statssa.gov.za/?p=16729#:%7E:text=In%20South%20Africa%2C%20deaths%20due,males%20and%2069%20for%20females.">Statistics South Africa</a>, there was an increase of 58% in deaths from non-communicable diseases from 1997 to 2018. <a href="https://www.statssa.gov.za/?p=16729">Diabetes is the second leading cause of death</a> in South Africa after tuberculosis. </p>
<p>Diabetes affects <a href="https://www.up.ac.za/faculty-of-health-sciences/news/post_2972065-our-research-shows-gaps-in-south-africas-diabetes-management-programme#:%7E:text=In%20South%20Africa%2C%20diabetes%20affects,89%2C834%20people%20died%20of%20diabetes.">12%</a> of the adult population, wreaking massive damage to individuals’ health and livelihoods, and to the national fiscus. The direct cost of diabetes to South Africa’s health system is <a href="https://www.wits.ac.za/news/latest-news/opinion/2022/2022-09/obesity-costs-south-africa-billions-we-did-the-sums.html">R2.7 billion</a> (US$150 million) – and that is only for those patients who are diagnosed. It does not factor in the indirect costs of loss of jobs and income. </p>
<p>If all cases were diagnosed and treated, PRICELESS SA, a research unit based at the School of Public Health at the University of the Witwatersrand, estimates this would cost R21.8 billion (US$1.2 billion) a year, rising to R35 billion (US$1.9 billion) in real terms by 2030.</p>
<p>Finance minister Enoch Godongwana will table the <a href="https://www.treasury.gov.za/comm_media/press/2023/2023091101%20MEDIA%20ADVISORY-MEDIUM%20TERM%20BUDGET%20POLICY%20STATEMENT%20DATE.pdf">medium-term budget</a> policy statement this week. Based on our <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30304-1/fulltext">research</a> and the experience elsewhere in the world, we believe Godongwana has an opportunity to improve both South Africa’s fiscal health and its public health in one swift, effective action: by increasing the Health Promotion Levy, better known as the “sugar tax” on beverages.</p>
<h2>Why the urgency?</h2>
<p>Most South Africans with diabetes are either diagnosed very late, by which time they are much sicker, or are not diagnosed at all. The SA Demographic Health Survey data from 2016, the most recent study, <a href="https://pubmed.ncbi.nlm.nih.gov/35236427/">found that 67% of all men and women were “pre-diabetic”</a> and suggested that a “large portion” of South Africans remained undiagnosed, and therefore untreated.</p>
<p>Untreated or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383848/">badly controlled diabetes</a> can result in amputations, kidney failure and blindness. Many of these same individuals also have high blood pressure and end up with stroke as a result of brain haemorrhage. </p>
<p>Obesity is known to be linked to diabetes – and rates of <a href="https://pubmed.ncbi.nlm.nih.gov/34986330/#:%7E:text=The%20accumulation%20of%20an%20excessive,prevalence%20of%20type%202%20diabetes.">obesity and overweight</a> people, too, are increasing relentlessly. Current rates of obesity in South Africa are 11% among men (with another 20.3% overweight), and 41% among women (with another 26.6% overweight). At this rate it is expected that <a href="https://s3-eu-west-1.amazonaws.com/wof-files/World_Obesity_Atlas_2022.pdf#page=25">50%</a> of South African women will be obese by 2030. </p>
<p>Both obesity and diabetes are known to be triggered by <a href="https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/how-much-sugar-is-too-much#:%7E:text=Men%20should%20consume%20no%20more,32%20grams">over-consumption</a> of sugar. <a href="https://pubmed.ncbi.nlm.nih.gov/31054268/">Liquid sugar</a> is known to be particularly harmful and has no nutritional value. This is why the public health recommends at least a 20% tax on sugary beverages. </p>
<p>The Health Promotion Levy should also include 100% fruit juices in the list of products subject to the tax.</p>
<h2>Sugar tax</h2>
<p>In 2018, in an attempt to address South Africa’s obesity, diabetes and other non-communicable diseases, National Treasury imposed a tax on sugar-sweetened beverages, known as the <a href="https://www.sars.gov.za/customs-and-excise/excise/health-promotion-levy-on-sugary-beverages/">Health Promotion Levy</a>. It equates to 2.1 cents per gram of sugar above a 4 gram threshold per 100 millilitres – which amounts to a levy of approximately 11% on the price.</p>
<p>As of June 2022, the sugar tax alone had raised more than R10 billion (US$750 million) in revenues that went directly to the treasury. Only R24 million (US$1.3 million) in 2019/2020 and R14 million (US$0.7 million) in 2020/2021 was allocated to expenditure on <a href="https://knowledgehub.health.gov.za/system/files/elibdownloads/2023-04/National%252520health%252520promotion%252520policy%252520and%252520strategy%2525202015%252520-%2525202019.pdf">“health promotion”</a>. </p>
<p>But the South African sugar industry fought the sugar tax from the outset. The tax started out at a lower rate than originally planned: it was designed to be <a href="https://www.who.int/news/item/11-10-2016-who-urges-global-action-to-curtail-consumption-and-health-impacts-of-sugary-drinks">20%</a> in line with World Health Organization recommendations, but was slashed to 11% because of sugar industry <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747348/">pressure</a> during a prolonged public consultation period. The already ailing industry alleged it would cause further job losses. </p>
<p>In reality, other global sugar market realities are the cause of declines in local sugar production and jobs. For example <a href="https://www.namc.co.za/wp-content/uploads/2017/09/Document-3-Legislative-environment.pdf">distorted global prices</a> are below South Africa’s cost of production. This predated the introduction of the sugar tax. </p>
<p>The South African government has not increased the sugar levy from its initial 11% in the five years since it started. It has put previously planned increases on hold. In the <a href="https://www.gov.za/speeches/minister-enoch-godongwana-2023-budget-speech-22-feb-2023-0000">February 2023 budget speech</a> the minister again imposed a two-year moratorium on the Health Promotion Levy, not even allowing for an inflation-related increase. In real terms, the sugar tax has effectively been reduced.</p>
<p>The South African Sugarcane Growers’ Association has <a href="https://apps.fas.usda.gov/newgainapi/api/Report/DownloadReportByFileName?fileName=South%20African%20Sugar%20Industry%20Crushed%20by%20Not%20So%20Sweet%20Tax_Pretoria_South%20Africa%20-%20Republic%20of_3-5-2019">expressed concern</a> at the prospect of an increase in the levy, fearing negative impacts on the sugar industry. Yet research from PRICELESS, analysing data from the <a href="https://www.statssa.gov.za/publications/P0211/P02112ndQuarter2019.pdf">South African Quarterly Labour Force Survey</a> from January 2008 to June 2019, shows that the sugar levy has had little effect on sugar-industry employment.
Even at its current weaker-than-ideal rate, the tax has reduced consumers’ consumption of sugary beverages by about 2g per capita per day, separate <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30304-1/fulltext">research</a> led by PRICELESS SA scientists shows. </p>
<h2>Government could turn the tide</h2>
<p>To reverse South Africa’s fatal diabetes trend and pour additional, much-needed billions into public funds, the government should increase the rate of the Health Promotion Levy to the 20% endorsed by the WHO. </p>
<p>Early detection and treatment is key to reducing the disabling effects of diabetes and the cost to the state. Therefore better diagnosis in the public health system should be prioritised – and funded from Health Promotion Levy revenues. </p>
<p>The fact that the Health Promotion Levy has already yielded more than R10 billion to the treasury is testament to its revenue potential. The win-win consequences of raising the levy seem indisputable.</p><img src="https://counter.theconversation.com/content/216456/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Goldstein receives funding from the Bloomberg Foundation and UK research foundations (UKRI and NIHR) as well as the IDRC. </span></em></p><p class="fine-print"><em><span>Karen Hofman 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>Diabetes affects about 12% of South Africa’s adult population.Karen Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandSusan Goldstein, Associate Professor in the SAMRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2135132023-09-15T13:57:29Z2023-09-15T13:57:29ZWhy taxing ‘junk food’ to tackle obesity isn’t as simple as it seems<p>Former prime minister Tony Blair has <a href="https://www.thetimes.co.uk/article/blair-calls-for-tax-on-junk-food-times-health-commission-2gd7hhh69">called for</a> more taxes on junk food to tackle the UK’s obesity crisis. This includes extending sugar taxes beyond just soft drinks, as well as taxing food that is high in salt and fat. Blair also called for restrictions on advertising unhealthy food.</p>
<p>The former PM believes this is the only way to save the NHS. “We’ve got to shift from a service that’s treating people when they’re ill to a service that is focused on wellbeing, on prevention, on how people live more healthy lives,” he told The Times Health Commission.</p>
<p>But is it as simple as that? A levy on sugary drinks was introduced in the UK in 2018 which led to drinks makers reformulating their products so they contained less sugar. A year later, the British public was <a href="https://www.medrxiv.org/content/10.1101/2023.06.26.23291902v1">consuming less sugar</a>. However, sugar consumption had been falling in Britain before the levy was introduced. Once this was factored into the analysis, there was no significant fall in sugar consumption. </p>
<p>Denmark experimented with a fat tax and it had similar underwhelming results. It was hailed as a world-leading public health policy when it was introduced in October 2011 but was abandoned 15 months later. </p>
<p>According to one survey, <a href="https://www.iea.org.uk/sites/default/files/publications/files/The%20Proof%20of%20the%20Pudding.pdf">only 7% of Danes</a> reduced the amount of butter, cream and cheese they bought. A different survey found that 80% did not change their food shopping habits at all.</p>
<p>However, whether or not levies on unhealthy food work is difficult to determine. Advocates for these programmes tend to highlight positive effects based on data modelling rather than actual changes in people’s weight and health. Detractors, on the other hand, quickly challenge such policies as being the enactment of the “nanny state”.</p>
<h2>Where and what to tax?</h2>
<p>Although the UK’s sugar tax led to drinks being reformulated to have less sugar, it also had some unintended consequences. For example, sugary drinks called slushies needed to have glycerol (E422) added to them to maintain their slush (artificial sweeteners failed to produce the required “slush”). </p>
<p>While this is safe for most older children and adults, the <a href="https://www.food.gov.uk/news-alerts/news/not-suitable-for-under-4s-new-industry-guidance-issued-on-glycerol-in-slush-ice-drinks">Food Standards Agency</a> identified a possible risk of <a href="https://www.foodstandards.gov.scot/news-and-alerts/glycerol-in-slush-ice-drinks">glycerol intoxication</a> in smaller children and suggested sales should be restricted to children five years old and older. </p>
<p>Another unintended consequence is making the poor poorer by raising the price of food. If taxes or levies are extended beyond drinks and sugar to include all food high in fat, salt and sugar, the cost of this reformulation is likely to be passed on to the consumer.</p>
<p>With the current cost of living crisis, this is simply not acceptable to politicians or many of the public. If such levies are introduced, they need to be a smarter version of the soft drinks industry levy. It should drive food producers to change the food they produce, making less healthy ingredients cost more while making it more profitable to grow and supply healthier food.</p>
<h2>What is ‘junk’ food?</h2>
<p>The next challenge is to identify which food to tax. </p>
<p>Blair suggested “junk food”, which he defined as high in fat, salt and sugar - often called <a href="https://www.gov.uk/government/publications/restricting-promotions-of-products-high-in-fat-sugar-or-salt-by-location-and-by-volume-price/restricting-promotions-of-products-high-in-fat-sugar-or-salt-by-location-and-by-volume-price-implementation-guidance">HFSS foods</a>. It is these foods that can no longer be advertised on <a href="https://evidence.nihr.ac.uk/alert/advertising-ban-was-linked-to-lower-purchases-of-unhealthy-food-and-drink/#:%7E:text=In%20February%202019%2C%20the%20transport,bus%20stops%2C%20and%20railway%20stations.">Transport for London</a> sites. </p>
<p>This has been hailed as a success. These restrictions on advertising are estimated to have <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003915">significantly decreased</a> the average amount of HFSS foods households buy each week. </p>
<p>This <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-022-01331-y">data</a> was then used to claim that this change reduced the number of people with obesity by <a href="https://www.lshtm.ac.uk/newsevents/news/2022/junk-food-advertising-restrictions-prevent-almost-100000-obesity-cases-and#:%7E:text=Restrictions%20for%20junk%20food%20advertising,Behavioural%20Nutrition%20and%20Physical%20Activity.">100,000</a>. This claim has been <a href="https://onlinelibrary.wiley.com/doi/10.1111/jhn.13155">heavily criticised</a>. It is an estimate, and the change in the number of people who are overweight or obese linked to the advertising ban is unknown. </p>
<p>So, although there may be some merit in tackling advertising, it perhaps needs to be smarter and respond to modern and emerging trends in advertising strategies. The focus on out-of-home advertising, which is the Transport for London approach, does not look at how social media and online advertising linked to cookies and trackers can build a message for potential consumers. Challenging how advertisers link campaigns across media is probably more effective. </p>
<p>An alternative is to focus where advertising is permitted. For example, regulating billboards near schools so that they only show healthy messages may be a more effective solution.</p>
<p>This is before considering the potentially stigmatising language in calling food “junk” food, especially given the message is focused on helping poorer people. Perhaps this is why there has been a move to use terms such as “ultra-processed food”. </p>
<p>Both, however, are slightly subjective. The HFSS definition could include cheese and Greek yoghurt and therefore might suggest that these foods receive an advertising ban. Whereas a fast-food meal with water and carrot sticks – although these may be the least popular meal option – can still be advertised. </p>
<p>When promoting healthier dietary choices, we need to make options like vegetables attractive. This can be difficult for people on low incomes, who might avoid trying new food that might be rejected and wasted. Instead, go for family favourites which might be less healthy but will make sure everyone is full within their budget. </p>
<p>So what are the answers? Perhaps not top-down approaches, such as those proposed by Blair. An example of how our food system can be changed has been set out in the <a href="https://www.birmingham.gov.uk/downloads/download/5219/birmingham_food_system_strategy">Birmingham Food System Strategy</a>. This sets out how small local food businesses make healthier food widely available across the city, as well as provide employment in the city. This sets out a community-led approach that encourages a city-wide food supply that is healthy for people and the planet. </p>
<p>To solve a complex problem you need subtle and connected changes in many areas that are designed with and are acceptable to those with the most to gain, but who are struggling on low incomes.</p><img src="https://counter.theconversation.com/content/213513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duane Mellor has provided technical nutrition advice to the slush drinks industry and out of home advertising industry. They are also a member of the British Dietetic Association.</span></em></p>Tony Blair has called on ministers to tighten food regulation, including adding levies to foods high in fat, salt and sugar.Duane Mellor, Lead for Evidence-Based Medicine and Nutrition, Aston Medical School, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2023682023-03-27T15:55:33Z2023-03-27T15:55:33ZProfit versus health: 4 ways big global industries make people sick<figure><img src="https://images.theconversation.com/files/517610/original/file-20230327-23-bpdhjq.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>It’s now more commonly known that <a href="https://www.who.int/news-room/fact-sheets/detail/alcohol">alcohol</a> and <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">tobacco use</a> make us ill. Less known is that just four industries account for at least one-third of global preventable deaths. These industries are: unhealthy processed food and drinks, fossil fuels, alcohol and tobacco. Collectively they cause 19 million deaths every year, according to a <a href="https://www.thelancet.com/series/commercial-determinants-health">recent series of reports</a> published in The Lancet. </p>
<p>These deaths happen because of accepted business practices that prioritise profit over health - and not only through the companies’ products. This include cigarettes that <a href="https://cansa.org.za/files/2021/05/Fact-Sheet-on-Tobacco-Products-May-2021.pdf">cause cancer</a>, sugary drinks that result in <a href="https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html">obesity</a> or coal that drives <a href="https://www.carbonbrief.org/the-carbon-brief-profile-south-africa/">carbon dioxide emissions</a>, for example. The world’s largest commercial companies routinely operate in a way that masks their practices and allows them to continue and expand in the name of <a href="https://journals.sagepub.com/doi/full/10.1177/1024529420910382">neoliberal economic freedoms</a>. </p>
<p>These transnational corporations <a href="https://www.thelancet.com/series/commercial-determinants-health">drive</a> rapidly rising sickness and death levels, disability, environmental damage, and widening social inequities. The Lancet series describes a “pathological system” in which a substantial group of commercial actors are increasingly enabled to cause harm and to make others pay the costs of doing so. They profit without bearing any of the costs of the harmful products marketed to an unsuspecting public. </p>
<p>Commercial actors must meet the actual costs of the harm they
cause if further damage is to be prevented. Governments will need to hold commercial actors to account. And norms need to be reshaped in the public interest, drawing attention to the right to health and the governmental obligation to protect health, not just corporate freedoms.</p>
<p>The commercial sector exists to make a profit. In the logic of the private sector, this outweighs public health and well-being considerations. Commercial activity’s health impacts can be positive, such as employing people in communities. But most are harmful. In public health, we call these <a href="https://www.who.int/health-topics/commercial-determinants-of-health#tab=tab_1">“commercial determinants of health”</a>.</p>
<p>The commercial practices that lead to these impacts range from legal to illegal, evident to subtle. They often overlap. At the same time, several types of practices used by commercial actors harm us. The most obvious are marketing, reputation management, questioning scientific evidence, and financial manipulation. </p>
<p>This matters because it is the unsuspecting public that pay. They bear the suffering and the costs of the global epidemic of noncommunicable diseases, and the rapidly accelerating climate emergency.</p>
<h2>Marketing: making people consume more</h2>
<p>The commercial sector uses various “dark marketing” strategies to create demand for brands and increase product consumption. Advertising for fast food and other ultra-processed food (high in fat, sugar and salt) dominates many countries’ advertising space. <a href="https://www.researchgate.net/publication/350707676_Exposure_of_Children_to_Unhealthy_Food_and_Beverage_Advertisements_in_South_Africa">Nearly half</a> of the advertisements viewed during child or family time in South Africa are for ultra-processed food and drink products. </p>
<p>A case study from South Africa that features in the Lancet series, on Coca-Cola’s marketing of sugar-sweetened drinks, illustrates how seemingly “normal” business practices can have devastating health impacts.</p>
<p>Coca-Cola and other beverage companies operate in South Africa in the context of alarming rates of obesity. Of <a href="https://health-e.org.za/2023/03/02/obecity-index-capetonians-carry-least-weight/">the obese</a> population, 68% are women, 31% are men and 13% are children. School children aged 10-13 consume at least <a href="https://www.ajol.info/index.php/jfecs/article/view/53995">two servings of sugary drinks</a> daily. This makes South Africa one of the <a href="https://www.coca-colacompany.com/press-releases/the-coca-cola-company-sabmiller-and-coca-cola-sabco-to-form-coca-cola-beverages-africa">top 10</a> global consumers of Coca-Cola products. </p>
<p>The company’s marketing practices target mostly poor South Africans, seen as its growth market. Its products are available everywhere, from supermarkets to street vendors and remote rural areas. Branding is pervasive, from school and shop signs to billboards, TV advertisements and social media presence. One under-discussed aspect of this practice is how marketing reshapes cultural norms. It makes a deadly product aspirational – much as the <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/marketing/index.htm">tobacco industry</a> did decades ago.</p>
<h2>Reputation management: covering their tracks</h2>
<p>Creating brand loyalty can fall into the realm of reputation management, sometimes in the guise of “corporate social responsibility”.</p>
<p>For example, some big food companies distributed unhealthy products with no nutritional value during the <a href="https://ncdalliance.org/news-events/news/new-report-details-hundreds-of-examples-of-unhealthy-commodity-industries-leveraging-the-covid-19-pandemic">COVID-19 pandemic</a>. Coca-Cola donated sugary drinks in <a href="https://www.youtube.com/watch?v=av2I8mhmWwY">Ghana</a>. Krispy Kreme donated doughnuts to <a href="https://www.independent.co.uk/life-style/food-and-drink/krispy-kreme-coronavirus-free-doughnuts-healthcare-workers-may-a9432236.html">frontline emergency workers</a> in the US. South African Breweries claimed to have recycled beer crates to make <a href="https://www.bizcommunity.com/Article/196/348/202947.html">face shields for health workers</a>.</p>
<p>The commercial sector seeks to influence policies so that they support the trade of harmful products or services. For example, the sugar industry in South Africa <a href="https://www.vitalstrategies.org/wp-content/uploads/Lessons-From-South-Africa-Campaign-for-a-Tax-on-Sugary-Beverages.pdf">successfully lobbied</a> to halve the proposed tax on sugary drinks.</p>
<p>The world’s largest tobacco company, Philip Morris International, has been <a href="https://www.businesslive.co.za/bd/national/health/2022-09-22-philip-morris-sa-calls-for-different-rules-for-its-differing-products/">calling for relaxed regulations</a> on advertising its “smoke-less” products in South Africa ahead of a new <a href="https://www.parliament.gov.za/bill/2307574">Control of Tobacco Products and Electronic Delivery Systems Bill</a>. </p>
<p>The alcohol industry once formed an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3260574/">interest group</a>, known as the Association for Responsible Alcohol Use, to influence government policies in South Africa.</p>
<h2>Skewing science</h2>
<p>Commercial influences on the scientific process can be subtle but pervasive. Funding research in non-transparent ways creates bias. Many commercial sectors attempt to manipulate scientific findings in their favour or to hide or falsify results. In 2017, for example, independent researchers uncovered how Exxon Mobil had intentionally <a href="https://www.globalcitizen.org/en/content/exxon-mobil-lied-about-climate-change/?gclid=CjwKCAjw_MqgBhAGEiwAnYOAemTBgfHbezOyci6Lzgrr8eTn0riC3PdzMzp7PT-jkUGscOc55G5bYBoCVVMQAvD_BwE">misled the public about how extractive activities contributed to climate change</a>.</p>
<p>Pharmaceutical companies use intellectual property rights to keep drugs at a high price. This limits access to medicines. Recently, <a href="https://www.npr.org/sections/goatsandsoda/2021/11/10/1052078529/why-low-income-countries-are-so-short-on-covid-vaccines-hint-its-not-boosters">COVID-19 vaccines</a> were affordable for only the wealthiest countries. The same thing happened <a href="https://oxfamilibrary.openrepository.com/bitstream/handle/10546/620381/bn-access-to-medicines-south-africa-010201-en.pdf?sequence=1&isAllowed=y">two decades earlier</a> with antiretroviral drugs for HIV.</p>
<h2>Financial manipulation: tax avoidance and more</h2>
<p>Multinational mining companies continue to <a href="https://www.imf.org/en/Blogs/Articles/2021/11/05/blog-countering-tax-avoidance-sub-saharan-africa-mining-sector">cheat Africa out of billions of dollars</a> by under-reporting profits and paying lower taxes. In Zambia, for example, copper earns transnational copper mining companies billions annually. It’s estimated that their corporate tax avoidance denies the country US$3 billion in taxes yearly. This is more than 12.5% of Zambia’s <a href="https://www.imf.org/en/Publications/Departmental-Papers-Policy-Papers/Issues/2021/09/27/Tax-Avoidance-in-Sub-Saharan-Africas-Mining-Sector-464850">entire GDP</a>.</p>
<p>Some companies exploit labour (for instance, in the agricultural sector) and pollute the environment (for example, in the mining sector). These practices harm human and environmental health but were previously considered “normal” modes of doing business.</p>
<h2>Looking ahead</h2>
<p>Many of these “routine” commercial methods overlap and support each other. Transnational corporations with deep pockets can use them particularly well in weakly regulated low- and middle-income countries.</p>
<p>Individuals and their families, civil society, and governments increasingly bear the costs of harm caused by corporations. </p>
<p>It will take concerted joint efforts, such as an international convention, to change the system. This change needs to be in the direction of prioritsing societal and environmental well-being and health impacts. Until this happens, health and equity will continue to be threatened, causing significant economic damage and declining social development. </p>
<p><em>This article is part of a media partnership between The Conversation Africa and PRICELESS SA, a research-to-policy unit based in the School of Public Health at the University of the Witwatersrand. Researchers from the SAMRC/ Wits Centre for Health Policy and Decision Science - also contributed to the Lancet Series on the commercial determinants of health.</em></p><img src="https://counter.theconversation.com/content/202368/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Teurai Rwafa 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>The public bears the suffering and costs of the global epidemic of noncommunicable diseases, and the rapidly accelerating climate emergency.Teurai Rwafa, Visiting Lecturer - Wits School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1999702023-02-24T06:59:00Z2023-02-24T06:59:00ZMore Indonesian children are living with diabetes – so what can we do to prevent it?<figure><img src="https://images.theconversation.com/files/512154/original/file-20230224-534-b4cons.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Regular exercise and heathy diets, including low consumption of processed foods, are important to prevent diabetes.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/children-in-the-kitchen-holding-slices-of-capsicum-3984735/">Pexels/Gustavo Fring</a></span></figcaption></figure><p>Indonesian children under 18 were 70 times more likely to be living with diabetes in January 2023 than they were in 2010, <a href="https://www.kompas.id/baca/english/2023/02/15/preventing-child-diabetes">the Indonesian Pediatric Society</a> revealed this month. </p>
<p>The Indonesian Pediatric Society said that <a href="https://www.bbc.com/indonesia/articles/clj6rene4y7o">the childhood diabetes prevalence has increased</a> from 0.028 per 100.00 children in 2010 to 2 per 100.000 children in January 2023. The authors have tried to searched for the original report, but it is not publicly available.</p>
<p>In addition to the Indonesian Pediatric Society data, two other peer-reviewed publications indicate that both <a href="https://www.researchgate.net/publication/348228590_Type_1_diabetes_mellitus_in_children_Experience_in_Indonesia">type 1</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177658/">type 2 diabetes</a> are increasing among Indonesian children. </p>
<p>Both types of diabetes are chronic conditions, meaning they are long lasting and can’t be cured. People with diabetes must consistently control their blood sugar to achieve optimal life. </p>
<p>Excess weight is a major risk factor for developing diabetes. It is why <a href="https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Type-2-Diabetes-A-Manageable-Epidemic.aspx">controlling diets</a> is vital for preventing overweight, obesity and diabetes. </p>
<p><a href="http://labdata.litbang.kemkes.go.id/images/download/laporan/RKD/2018/Laporan_Nasional_RKD2018_FINAL.pdf">The 2018 National Health Research report</a> showed that a tenth of Indonesian children between the age of 5 and 12 years old were obese. </p>
<p>As a researcher in infant and young child feeding, and an accredited practising dietitian, we find that encouraging healthy family diets for children from the time they are babies is one way to keep children’s blood sugar levels in check. </p>
<h2>Preventing diabetes in children with breastmilk from birth</h2>
<p>There are two main types of diabetes: type 1 and type 2 diabetes.</p>
<p>The most typical diabetes diagnosed in children is <a href="https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Diabetes.aspx">type 1 diabetes</a>. It happens when the body cannot produce enough of a hormone (insulin) to regulate turning food into energy. </p>
<p>The cause of type 1 diabetes is unclear, though it is often considered genetic. However, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481976/">many studies</a> have shown <a href="https://www.diabetesincontrol.com/breastfeeding-helps-to-prevent-type-1-diabetes/">breastfeeding reduces the risk of type 1 diabetes</a>.</p>
<p>Type 2 diabetes can be diagnosed in children and is preventable. The risk factors of <a href="https://www.healthdirect.gov.au/diabetes">type 2 diabetes</a> are also genetic. </p>
<p>A study <a href="https://academic.oup.com/nutritionreviews/article/70/9/509/1835283">has shown</a> the benefit of breastfeeding in preventing <a href="https://academic.oup.com/ajcn/article/109/Supplement_1/817S/5456706">the risk of type 1 diabetes for babies</a>, as well as avoiding the risk of <a href="https://link.springer.com/article/10.1007/s11892-019-1121-x">type 2 diabetes across the lifespan</a>. </p>
<p>The first 1000 days of life significantly impact <a href="https://healthyeatingresearch.org/wp-content/uploads/2017/02/her_feeding_guidelines_report_021416-1.pdf">child development</a>, including predicting their future diet. </p>
<p>WHO and UNICEF <a href="https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding">recommend</a> parents initiate breastfeeding immediately after birth for at least 30 minutes, with exclusive breastfeeding from birth until six months old, complementary feeding from 6 months old and to continue breastfeeding until two years old or beyond. </p>
<p>After two years old, a child does not need milk, though breastmilk may still be given because it can help <a href="https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Breastfeeding-Benefits-Your-Babys-Immune-System.aspx">increase a child’s immunity</a>.</p>
<h2>Avoiding high sugar Growing-Up Milk</h2>
<p>Many parents feel that the child’s nutrition is complete with Growing-Up Milk (GUM), sometimes called Toddler Milk. GUM is marketed for children aged between 12 and 36 months old.</p>
<p>However, an <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13186">Indonesian study</a> has shown that GUM tends to be high in sugar. The average sugar content in GUM in the Indonesian market is 7.3 grams per 100 ml (equal to the sugar in lemonade). The study echoes similar research that <a href="https://journals.co.za/doi/abs/10.7196/SAMJ.2019.v109i5.13314">identified high sugar content</a> in baby foods in South Africa. </p>
<p>Many GUMs distributed in Indonesia claim health benefits for children. However, the sugar content in them make them inappropriate for a child’s diet. </p>
<p>Instead of GUM, parents should give children from 6 months of age fresh and locally sourced foods. They should be prepared accordingly to the family’s diet. </p>
<p>A wide variety of fruits, vegetables and whole grains should also be given to children. Fruits, vegetables and whole grains are rich in nutrients and are shown to <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">be effective in preventing diabetes</a>. </p>
<h2>What can the government do?</h2>
<p>The government should focus on promoting breastfeeding and providing <a href="https://www.hse.ie/file-library/sroi-on-phn-led-breastfeeding-groups-main-report.pdf">support</a> because breastfeeding is effective <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5334-8">in reducing diabetes risk</a>, improves <a href="https://pubmed.ncbi.nlm.nih.gov/33413439/">child immunity</a> and brings [<a href="https://pubmed.ncbi.nlm.nih.gov/34602882/">economic benefits</a>].</p>
<p>The government should also control the distribution and <a href="https://www.who.int/publications/i/item/9241541601">marketing of breastmilk substitutes</a> and <a href="https://www.who.int/publications/i/item/WHO-NMH-NHD-19.27">GUM</a>, which can be misleading.</p>
<p>So far, the Indonesian government has introduced <a href="http://hukor.kemkes.go.id/uploads/produk_hukum/PMK%20No.%2049%20ttg%20Standar%20Mutu%20Gizi,%20Pelabelan,%20Periklanan%20Susu%20Formula.pdf">labelling and marketing standards</a> for Growing-Up Milk, but it could do more by stopping the cross-promotion of infant formula and Growing-Up Milk.</p>
<p>The government should also consider a sugar tax. </p>
<p>The sugar tax aims to reduce sugar consumption by reducing the affordability of buying sugar-based products. </p>
<p><a href="https://link.springer.com/article/10.1007/s40258-021-00685-x">A systematic review</a> has shown the effectiveness of this policy. </p>
<p>However, we suggest combining this policy with other interventions, such as increasing health literacy and opportunities for physical activity, particularly among children.</p><img src="https://counter.theconversation.com/content/199970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Para penulis tidak bekerja, menjadi konsultan, memiliki saham atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi di luar afiliasi akademis yang telah disebut di atas.</span></em></p>For parents, encouraging healthy family diets for children from the time they are babies is one way to keep children’s blood sugar levels in check. The Indonesian government can do more to help too.Andini Pramono, PhD Candidate, Department of Health Economics, Wellbeing and Society, National Centre for Epidemiology and Population Health, Australian National UniversityKatelyn Barnes, Postdoctoral Research Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927422022-10-27T19:26:41Z2022-10-27T19:26:41ZHow taxing sugary drinks reinforces weight stigma<figure><img src="https://images.theconversation.com/files/491565/original/file-20221025-246-osvds4.jpg?ixlib=rb-1.1.0&rect=4%2C98%2C2972%2C2090&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Newfoundland and Labrador has implemented a tax of 20 cents per litre on sugary drinks.</span> <span class="attribution"><span class="source">(AP Photo/Jenny Kane)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-taxing-sugary-drinks-reinforces-weight-stigma" width="100%" height="400"></iframe>
<p>Newfoundland and Labrador made history in September as the first Canadian province to <a href="https://www.cbc.ca/news/canada/newfoundland-labrador/rethink-your-drink-campaign-1.6548570">implement a sugar-sweetened beverage tax</a>. Sugar-sweetened beverage taxes also exist outside of Canada, including in <a href="https://doi.org/10.1017/s1368980016003086">Mexico, Philadelphia, Penn. and the United Kingdom</a>. In Newfoundland and Labrador the tax amounts to <a href="https://www.gov.nl.ca/budget/2021/what-you-need-to-know/promoting-a-healthier-newfoundland-and-labrador">20 cents per litre</a> of sugar-sweetened beverage.</p>
<p>Sugar-sweetened beverage taxation is supported by many global and national health organizations, such as the <a href="https://www.who.int/europe/publications/i/item/WHO-EURO-2022-5721-45486-65112">World Health Organization</a>, <a href="https://www.diabetes.ca/advocacy---policies/our-policy-positions/sugar---diabetes">Diabetes Canada</a> and the <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/position-statement/liquidcandy-factsheet-en.ashx?la=en&hash=E21D8E5A8708FD82915931DEC2C768361D130CC7">Heart and Stroke Foundation</a>. Taxes are a popular public health policy because of associations between sugary beverage consumption and <a href="https://doi.org/10.2337/dc10-1079">Type 2 diabetes</a> and <a href="https://doi.org/10.3945/ajcn.113.058362">weight gain</a>. </p>
<p>Sugar-sweetened beverage taxes are excise taxes, or flat taxes, which also make them regressive taxes. This type of taxation has real potential to have <a href="https://theconversation.com/a-sin-tax-on-sugary-drinks-unfairly-targets-indigenous-communities-instead-of-improving-health-155108">harmful effects on equity</a> as lower-income populations will pay a higher proportion of their income through this tax. Previous critiques of sugar-sweetened beverage taxation also include the <a href="https://vocm.com/2022/09/06/opposition-fielding-questions-on-new-sugar-tax/">potential harm to small business</a> and First Nations communities.</p>
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Read more:
<a href="https://theconversation.com/a-sin-tax-on-sugary-drinks-unfairly-targets-indigenous-communities-instead-of-improving-health-155108">A sin tax on sugary drinks unfairly targets Indigenous communities instead of improving health</a>
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<h2>Weight stigma</h2>
<p>Notably absent from this list of harms is the potential of sugar-sweetened beverage taxation to create or exacerbate stigma, including weight stigma. Weight stigma in health policies has received global attention and there are <a href="https://doi.org/10.1038/s41591-020-0803-x">many calls to action</a> to end <a href="https://doi.org/10.1016/S2468-2667(19)30186-0">weight-stigmatizing policies</a>.</p>
<figure class="align-center ">
<img alt="Overweight parents walking outdoors with their child" src="https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=509&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=509&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=509&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=639&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=639&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=639&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">Weight stigma includes stereotypes of laziness and stupidity, which are not supported by evidence.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Stigma occurs, in part, when a label — such as “obesity” — is associated with negative stereotypes, <a href="https://doi.org/10.1146/annurev.soc.27.1.363">leading to discrimination and loss of status</a>. Weight stigma includes stereotypes of <a href="https://doi.org/10.1037//0278-6133.22.1.68">laziness and stupidity</a>. It can lead to <a href="https://doi.org/10.1038/oby.2008.636">discrimination in health-care and workplace settings</a>. </p>
<p>Weight stigma has negative effects on <a href="https://doi.org/10.1111/cob.12264">mental</a> and <a href="https://doi.org/10.1111/jan.13511">physical health</a>, including <a href="https://doi.org/10.1038/sj.ijo.0803105">health-care avoidance</a>, <a href="https://doi.org/10.1016/j.eatbeh.2020.101383">disordered eating</a>, <a href="https://doi.org/10.1186/s12889-021-10565-7">self exclusion from sport and exercise</a> and <a href="https://doi.org/10.1111/jan.13511">stress</a>. Contrary to what many people think, <a href="https://doi.org/10.2105%2FAJPH.2009.159491">stigma is not an effective strategy for weight loss</a>. </p>
<p>Even before Newfoundland and Labrador declared its intentions with sugar-sweetened beverage taxation, significant interest in Canada and globally led us to explore attitudes and acceptability of a tax in our province of Manitoba. We conducted an <a href="http://hdl.handle.net/1993/36863">interview-based study</a> with residents of many different locations, including a middle-to-upper class, liberal neighbourhood in the provincial capital, Winnipeg. </p>
<p>Our participants from this location were white, food secure and primarily highly educated. In our analysis, we specifically sought out instances of weight stigma in the interview transcripts. </p>
<h2>Stigmatizing messages</h2>
<p>We were interested in the language participants used because people absorb the messages they hear and the images they see. They may push back, change or repeat these messages. </p>
<figure class="align-center ">
<img alt="A hand pouring sugar out of a soda can" src="https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&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">People absorb the messages they hear and the images they see.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>In our analysis of the interviews, we found that many participants repeated weight-stigmatizing messages when discussing sugar-sweetened beverages. A more overt way this occurred was through the judgement of higher-weight individuals who were buying or consuming sugar-sweetened beverages. </p>
<p>Weight stigma also occurred in more covert or subtle ways. For example, some participants talked about their “disgust” and other negative emotions associated with their weight and others’ weight. Many participants also spoke of their “responsibility” to lose weight or to protect their children from becoming overweight by not consuming sugar-sweetened beverages and juice. </p>
<p>Weight dissatisfaction is <a href="https://doi.org/10.1155/2013/291371">harmful to one’s health</a>. Disgust also has justice implications for public health. Being disgusted by someone <a href="https://doi.org/10.1080/09581596.2014.885115">makes them seem less than human. It can contribute to blaming people</a> for conditions caused by multiple biological and social factors and can reinforce prejudice. </p>
<p>Participants also described higher weight individuals as a “burden” on the health-care system and that a tax on sugar-sweetened beverages would help offset these perceived costs. While this myth of obesity bankrupting the health-care system is pervasive, research suggests otherwise. In Manitoba, the health service usage for <a href="http://mchp-appserv.cpe.umanitoba.ca/reference/MCHP-Obesity_Report_WEB.pdf">individuals classified as overweight was found to be similar to those classified as normal weight</a>. Health-care usage was only marginally higher for individuals classified as obese. </p>
<h2>Policies and stigma</h2>
<p>Hearing these comments repeated in our interviews indicated to us how pervasive and widespread weight stigma was in participants’ attitudes toward sugar-sweetened beverage intake. Most importantly, these beliefs informed support or acceptability of sugar-sweetened beverage taxation. </p>
<p>This finding echoes <a href="https://doi.org/10.1016/j.socscimed.2013.09.023">existing research suggesting reciprocal processes</a> between stigma at inter- and intra-personal levels and policies. This indicates that interpersonal stigma may contribute to the creation of stigmatizing policies and that stigmatizing policies may in turn legitimize and worsen existing stigma. </p>
<p>Our specific research population was chosen because it was a good representation of the dominant social group in Canada — a white, middle-to-upper class, highly educated segment of the population. This dominant population is also likely to be similar to many policymakers, further supporting the perspectives of this group within Canadian policies. </p>
<p>Our findings demonstrate how weight-stigmatizing comments were used in support of sugar-sweetened beverage taxation. Weight stigma has <a href="https://theconversation.com/how-anti-fat-bias-in-health-care-endangers-lives-115888?">serious health consequences</a>. If Canadian <a href="https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-toward-more-inclusive-health-system.html">public health professionals</a> are committed to tackling weight stigma in health policies, we need to reconsider our support for this policy.</p><img src="https://counter.theconversation.com/content/192742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Katherine Anderson Waugh received Canada Graduate Scholarship-Masters funding from CIHR. She has also received funding from the University of Manitoba, Faculty of Graduate Studies. </span></em></p><p class="fine-print"><em><span>Andrea Bombak receives funding from New Brunswick Health Research Foundation, Social Sciences and Humanities Research Council, and Banting Discovery Award. </span></em></p><p class="fine-print"><em><span>Natalie Diane Riediger receives funding from the Canadian Institutes of Health Research, Canadian Celiac Association, Social Sciences and Humanities Research Council, University of Manitoba, Mitacs, and Universities Canada. </span></em></p><p class="fine-print"><em><span>Patty Thille currently receives funding from Research Manitoba. </span></em></p><p class="fine-print"><em><span>Kerstin Roger 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>Taxation of sugar-sweetened drinks is not only inequitable, but also has the potential to create or perpetuate weight stigma, which has negative effects on mental and physical health.Anne Katherine Anderson Waugh, Research Coordinator, Department of Food and Human Nutritional Sciences, University of ManitobaAndrea Bombak, Associate professor, Department of Sociology, University of New BrunswickKerstin Roger, Full Professor, Department of Community Health Sciences, University of ManitobaNatalie Diane Riediger, Assistant Professor of Nutritional Epidemiology, University of ManitobaPatty Thille, Assistant Professor in Physical Therapy, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923932022-10-20T19:05:05Z2022-10-20T19:05:05ZAustralia is dragging its feet on healthy eating. In 5 years we’ve made woeful progress<figure><img src="https://images.theconversation.com/files/490787/original/file-20221020-24-oumd8q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4673%2C2986&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/caucasian-senior-woman-pushing-trolley-supermarket-2170712659">Shutterstock</a></span></figcaption></figure><p>Australia is falling behind other countries in addressing the unhealthy state of our diets.</p>
<p>Several other countries, including the United Kingdom, Canada and Mexico, have recently taken major steps to help improve population nutrition and prevent obesity.</p>
<p>But our <a href="https://www.foodpolicyindex.org.au/federal">latest assessment</a>, released as part of the <a href="https://www.icocongress.org/">International Congress on Obesity</a>, has found major holes in Australian government policy relative to international best practice, with limited policy progress in the past five years. </p>
<h2>What we assessed?</h2>
<p>Our assessment of the federal government included a scorecard of how Australia is going in 50 policy areas for addressing unhealthy diets. These policy areas include key influences on what we buy and what we eat, including policies that affect the price and affordability of different foods, the types of food available, how food is labelled, and the way food is promoted.</p>
<p>We worked closely with government officials to document current action in each policy area. We then assessed how existing policies compared to international benchmarks.</p>
<p>Finally, we made recommendations to address the gaps, prioritising them based on their relative importance and feasibility. Eighty-four experts from 37 organisations participated in the assessment and prioritisation process.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-its-not-just-a-lack-of-control-that-makes-australians-overweight-heres-whats-driving-our-unhealthy-food-habits-162512">No, it’s not just a lack of control that makes Australians overweight. Here’s what’s driving our unhealthy food habits</a>
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<h2>How does Australia compare to other countries?</h2>
<p>We found implementation of globally recommended policies for improving population diets and addressing obesity in Australia falls far short of international best practice.</p>
<p>There has been only limited policy progress in Australia in the past five years.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490519/original/file-20221019-23-fgvki4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/490519/original/file-20221019-23-fgvki4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490519/original/file-20221019-23-fgvki4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=676&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490519/original/file-20221019-23-fgvki4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=676&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490519/original/file-20221019-23-fgvki4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=676&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490519/original/file-20221019-23-fgvki4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=849&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490519/original/file-20221019-23-fgvki4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=849&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490519/original/file-20221019-23-fgvki4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=849&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<h2>Areas where Australia is doing well</h2>
<p>One of the only areas where Australia fared well was in the area of food labelling, where some of the regulations regarding ingredient lists, nutrition information panels and health claims was rated among the best in the world.</p>
<p>The other area that scored Australia top marks is that the GST does not apply to fresh fruit and vegetables, which helps lower their prices relative to other less healthy products.</p>
<h2>What are other countries doing better?</h2>
<p>Several other countries have implemented policies to limit the marketing of unhealthy foods and make it easier for people to choose healthier options.</p>
<p>Countries in Latin America are leading the way globally. Chile has <a href="https://www.nytimes.com/2018/02/07/health/obesity-chile-sugar-regulations.html">put in place</a> comprehensive restrictions on TV advertising for unhealthy food, conspicuous warning labels on the packaging of unhealthy products, as well as taxes on sugary drinks. Mexico has <a href="https://ncdalliance.org/why-ncds/video-stories-of-change/mexicos-junk-food-bans">similar policies</a>.</p>
<figure class="align-right ">
<img alt="Food warning label for Oreos" src="https://images.theconversation.com/files/490522/original/file-20221019-14-nci790.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/490522/original/file-20221019-14-nci790.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1067&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490522/original/file-20221019-14-nci790.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1067&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490522/original/file-20221019-14-nci790.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1067&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490522/original/file-20221019-14-nci790.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1340&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490522/original/file-20221019-14-nci790.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1340&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490522/original/file-20221019-14-nci790.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1340&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">The warning labels on this product sold in Chile indicate it is high in energy (calories), sugar, saturated fats and sodium (salt).</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tijuana-mexico-september-24-2020-processed-1821237416">Shutterstock</a></span>
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<p>Elsewhere in the world, <a href="https://www.obesityevidencehub.org.au/collections/prevention/countries-that-have-implemented-taxes-on-sugar-sweetened-beverages-ssbs">more than 50 countries</a> now have taxes on sugary drinks. There is <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003412">clear evidence</a> these taxes have decreased consumption of the taxed products, while also incentivising soft drink manufacturers to reduce the sugar content of their drinks.</p>
<p>Several other governments are taking strong action to protect children from exposure to marketing of unhealthy food. As an example, the United Kingdom is set to <a href="https://www.gov.uk/government/news/new-advertising-rules-to-help-tackle-childhood-obesity">ban ads</a> for unhealthy food online, and on TV before 9pm from 2024. Canada has <a href="https://www.parl.ca/legisinfo/en/bill/44-1/c-252">similar laws</a> before their parliament.</p>
<p>The UK also just introduced <a href="https://www.gov.uk/government/publications/restricting-promotions-of-products-high-in-fat-sugar-or-salt-by-location-and-by-volume-price">major changes</a> to how supermarkets operate. Laws that came into effect this month mean unhealthy products can no longer be displayed in prominent in-store locations, such as shop entrances and checkout areas.</p>
<p>In addition, the UK has proposed a <a href="https://www.gov.uk/government/news/promotions-of-unhealthy-foods-restricted-from-october-2022">ban</a> on price discounts on unhealthy food, although implementation remains <a href="https://www.ft.com/content/5fcedf1f-1b86-4896-8ed2-5c51de415f17">uncertain</a> with the recent change in government leadership.</p>
<p>Several other innovative policies are in place internationally. For example, in some parts of Mexico, retailers <a href="https://www.theguardian.com/food/2020/aug/06/mexico-oaxaca-sugary-drinks-junk-food-ban-children">cannot sell</a> unhealthy food to children. And in Argentina, there are <a href="https://www.nycfoodpolicy.org/salt-reduction-law-argentina-urban-food-policy-snapshot/">laws</a> dictating maximum sodium (salt) content in a range of products. </p>
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Read more:
<a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">Sugary drinks tax is working – now it's time to target cakes, biscuits and snacks</a>
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<h2>How bad are Australian diets?</h2>
<p>Unhealthy diets and obesity are the <a href="https://www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-causes-of-illness-and-death-in-aus/summary">leading contributors</a> to poor health in Australia.</p>
<p>Less than <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/dietary-behaviour/latest-release">7%</a> of people in Australia consume a healthy diet consistent with the <a href="https://www.eatforhealth.gov.au/guidelines">Australian Dietary Guidelines</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"963299218889854976"}"></div></p>
<p>Nearly <a href="https://www.aihw.gov.au/reports/australias-health/overweight-and-obesity">65% of Australian adults</a>, and 25% of Australian children are overweight or obese. </p>
<p>While there isn’t good data on how these statistics have changed in the past few years, things have likely got <a href="https://www1.racgp.org.au/newsgp/clinical/one-in-three-australians-have-gained-weight-during">worse</a> since the start of the COVID pandemic.</p>
<p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32822-8/fulltext">Unless</a> we see comprehensive government action to improve population diets, there will be enormous <a href="https://www.mja.com.au/journal/2010/192/5/cost-overweight-and-obesity-australia">health and financial costs</a> to individuals, communities and the economy overall. </p>
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Read more:
<a href="https://theconversation.com/bmi-is-underestimating-obesity-in-australia-waist-circumference-needs-to-be-measured-too-89156">BMI is underestimating obesity in Australia, waist circumference needs to be measured too</a>
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<h2>What actions should Australia take?</h2>
<p>Federal government policy action is <a href="https://www.opc.org.au/what-we-do/tipping-the-scales">needed</a> to improve population diets and address obesity. This includes:</p>
<ul>
<li><p>protecting children from exposure to the marketing of unhealthy food and beverages through comprehensive and consistent national legislation</p></li>
<li><p>implementing a health levy on sugar-sweetened beverages (a sugar tax) and other unhealthy food, while addressing the affordability of healthy food</p></li>
<li><p>improving food labelling by mandating the <a href="http://www.healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/content/home">Health Star Rating scheme</a> and requiring warning labels on products high in added sugar, sodium (salt) and/or saturated fat. </p></li>
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<h2>What’s holding us back?</h2>
<p>In the past 12 months, the former federal government released key strategies in this area, including the <a href="https://www.health.gov.au/resources/publications/national-preventive-health-strategy-2021-2030">National Preventive Health Strategy (2021-2030)</a> and the <a href="https://www.health.gov.au/resources/publications/national-obesity-strategy-2022-2032">National Obesity Strategy (2022-2032)</a>. But this has yet to result in any changes on the ground.</p>
<p>Critically, there is strong <a href="https://www.opc.org.au/media/media-releases/aussies-support-push-to-protect-kids-from-unhealthy-marketing.html">support</a> from the Australian community for governments to impose higher standards on marketing to support children’s health and wellbeing. More than <a href="https://www.nature.com/articles/s41430-022-01211-5">75% of Australians</a> also back warning labels on unhealthy foods.</p>
<p>It is promising to see momentum building around a <a href="https://www.smh.com.au/politics/federal/gp-turned-mp-to-demand-action-on-junk-food-advertising-20220805-p5b7kh.html">legislative ban</a> on the marketing of unhealthy food and beverages to children.</p>
<p>But it’s now time for the federal government to catch up to the rest of the world and implement meaningful policy change to help Australians improve their diets.</p><img src="https://counter.theconversation.com/content/192393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Sacks receives funding from the the National Heart Foundation of Australia, National Health and Medical Research Council, Australian Research Council and VicHealth.</span></em></p><p class="fine-print"><em><span>Davina Mann 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>Unlike some other countries, junk food remains inexpensive and easily accessible in Australia and is widely marketed to kids.Gary Sacks, Associate Professor, Deakin UniversityDavina Mann, Research Fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1624342021-06-10T01:16:06Z2021-06-10T01:16:06ZHow much longer do we need to wait for Australia to implement a sugary drinks tax?<figure><img src="https://images.theconversation.com/files/405521/original/file-20210609-39830-7zo37v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bottles-soda-drinks-supermarket-109206149">Shutterstock</a></span></figcaption></figure><p>The Australian Medical Association (AMA) has <a href="https://ama.com.au/media/sugar-tax-will-cut-disease-and-save-lives">once again called for</a> a tax on sugary drinks in Australia. This time, the proposed tax is a key part of the AMA’s <a href="https://ama.com.au/vision-for-australias-health">blueprint</a> to make Australia the healthiest country in the world.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1402461952992026624"}"></div></p>
<p>The strong call for a sugary drinks tax echoes the concerted <a href="https://www.abc.net.au/radionational/programs/drive/sugar-is-toxic:-australian-of-the-year-calls-for-sugar-tax/11904210">campaign</a> by 2020 Australian of the Year, Dr James Muecke. </p>
<p>And it follows years of advocacy from <a href="https://www.opc.org.au/what-we-do/tipping-the-scales">public health groups</a> and <a href="https://grattan.edu.au/wp-content/uploads/2016/11/880-A-sugary-drinks-tax.pdf">think tanks</a> that have long-argued the many potential benefits of a sugary drinks tax for Australia.</p>
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Read more:
<a href="https://theconversation.com/lets-declare-war-on-type-2-diabetes-australian-of-the-year-james-muecke-on-why-we-need-to-cut-back-on-sugar-131024">Let’s 'declare war on type 2 diabetes' – Australian of the year James Muecke on why we need to cut back on sugar</a>
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<h2>What does the evidence say?</h2>
<p>A sugary drinks tax is <a href="https://www.who.int/news/item/11-10-2016-who-urges-global-action-to-curtail-consumption-and-health-impacts-of-sugary-drinks">consistently identified</a> as a critical part of efforts to improve our diets and prevent obesity.</p>
<p>There is strong <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y#page=22&zoom=100,0,0">evidence</a> linking sugary drink consumption to a range of negative health effects including tooth decay, excess weight gain, and increased risk of developing obesity and type 2 diabetes.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/33929703/">International evidence</a> clearly shows sugary drinks taxes are effective in reducing consumption of the taxed products.</p>
<p>Available <a href="https://pubmed.ncbi.nlm.nih.gov/33411708/">evaluations</a> have also consistently shown taxes on sugary drinks lead to increases in purchases of untaxed drinks, particularly bottled water. These effects have been shown to persist over many years. </p>
<h2>What tax design works best?</h2>
<p>The AMA <a href="https://ama.com.au/articles/tax-sugar-sweetened-beverages-what-modelling-shows">proposes</a> Australia implement a tax of A$0.40 per 100 grams of sugar (per unit of product). Under the proposed tax rate, the amount of tax paid on a 375ml can of Coke with 40g sugar (sugar content is 10.6g/100ml) would be A$0.16.</p>
<p>This tax rate is consistent with <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y">global recommendations</a> that price increases of at least 20% are needed to have a meaningful health effect.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Higher prices encourage people to choose healthier options, like bottled water.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soft-drinks-371246386">Shutterstock</a></span>
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<p>The proposed AMA tax design is also in line with <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003412">international evidence</a> that shows sugary drink taxes work best when the tax rate is based on sugar content.</p>
<p>These taxes can incentivise people to switch to healthier (lower sugar) substitutes while simultaneously incentivising manufacturers to reformulate their products (lowering the sugar content) to avoid a higher tax rate.</p>
<p>For example, the UK has <a href="https://www.bmj.com/content/372/bmj.n254">documented</a> success with a tiered approach, whereby products with sugar content above particular thresholds attract high tax rates. The UK tax has led to decreases in consumption and impressive levels of <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003025">reformulation</a>.</p>
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Read more:
<a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">Sugary drinks tax is working – now it's time to target cakes, biscuits and snacks</a>
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<p>The products to be taxed under the AMA proposal include all non-alcoholic drinks containing free sugars, but exclude 100% fruit juice, milk-based and cordial drinks.</p>
<p>Given the international and Australian evidence of the <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5">fierce opposition</a> to sugary drinks taxes from the food industry, practical decisions such as this are likely to help reduce resistance to the tax (from fruit growers, for example, and the dairy industry).</p>
<h2>Impact of a sugary drinks tax in Australia</h2>
<p>The AMA estimates the proposed tax would lead to reduced sugar consumption, improved diets and a <a href="https://ama.com.au/articles/tax-sugar-sweetened-beverages-what-modelling-shows">2% reduction in obesity</a>.</p>
<p>Over a 25-year period, <a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">modelling</a> has shown this would result in 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of heart disease, 1,100 fewer cases of stroke, and 1,600 fewer deaths.</p>
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Read more:
<a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">Australian sugary drinks tax could prevent thousands of heart attacks and strokes and save 1,600 lives</a>
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<p>These health benefits would <a href="https://ama.com.au/articles/tax-sugar-sweetened-beverages-what-modelling-shows">translate</a> to health-care expenditure savings of between A$609 million and A$1.73 billion.</p>
<p>The AMA estimates the tax would raise government revenue of around A$800 million each year. This revenue could be earmarked for preventive health initiatives.</p>
<h2>International groundswell of support for sugary drinks taxes</h2>
<p>There is global momentum behind sugary drinks taxes.</p>
<p>Sugary drinks taxes are now in place in more than <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y#page=22&zoom=100,0,0">45 countries</a> around the world. The majority of these taxes have been implemented in the last five years.</p>
<figure class="align-center ">
<img alt="Orange sodas from Mexio in esky." src="https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&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 taxes now operate in 45 countries, including Mexico.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/costa-mesa-californiaunited-states-08252019-several-1514465477">Shutterstock</a></span>
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<p>While Australia led the world in preventive health for many decades through strong action on <a href="https://tobaccocontrol.bmj.com/content/12/suppl_2/ii1">tobacco control</a>, it is now lagging <a href="https://6caf7727-1efc-419a-8b13-d58f79d7351f.filesusr.com/ugd/2e3337_e5e00a466691430488f99ed1f4a357af.pdf">far behind</a> in efforts to address unhealthy diets.</p>
<h2>Arguments against sugary drinks taxes</h2>
<p>The food industry routinely parades a <a href="https://www.obesityevidencehub.org.au/collections/prevention/arguments-against-an-ssb-tax-in-australia">range of arguments</a> against sugary drinks taxes. But their arguments have been <a href="https://theconversation.com/dont-believe-the-myths-taxing-sugary-drinks-makes-us-drink-less-of-it-130694">thoroughly debunked</a>. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-believe-the-myths-taxing-sugary-drinks-makes-us-drink-less-of-it-130694">Don't believe the myths – taxing sugary drinks makes us drink less of it</a>
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<p>For example, the food industry has <a href="https://theconversation.com/rejecting-a-sugar-tax-is-based-on-faulty-logic-about-the-poor-50230">argued</a> a sugary drinks tax would leave disadvantaged people poorer. </p>
<p>But <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002326">rigorous studies</a> indicate lower socioeconomic groups would likely experience a disproportionate health <em>benefit</em> as a result of the tax.</p>
<p>Industry has also <a href="https://www.britishsoftdrinks.com/write/MediaUploads/Publications/The_Economic_Impact_of_the_Soft_Drinks_Levy.pdf">claimed</a> there would be job losses for sugar producers.</p>
<p>The AMA report makes it clear a sugary drinks tax in Australia would have minimal impact on Australia’s sugar industry. This is because <a href="https://grattan.edu.au/report/a-sugary-drinks-tax-recovering-the-community-costs/">about 80%</a> of Australia’s domestic sugar production is exported.</p>
<h2>Time to put health above corporate profits</h2>
<p>The failure of the Australian government to implement a sugary drinks tax is a clear case of putting corporate interests ahead of population health. </p>
<p>Given the powerful evidence indicating the likely benefits and <a href="https://bmjopen.bmj.com/content/9/6/e027962">strong public support</a> for a sugary drinks tax, its implementation in Australia feels inevitable.</p>
<p>All that’s needed is political leadership that recognises the value of prioritising health above the profits of a select few multinational soft drinks manufacturers.</p>
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<strong>
Read more:
<a href="https://theconversation.com/sweet-power-the-politics-of-sugar-sugary-drinks-and-poor-nutrition-in-australia-95873">Sweet power: the politics of sugar, sugary drinks and poor nutrition in Australia</a>
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<img src="https://counter.theconversation.com/content/162434/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Sacks receives funding from the National Heart Foundation of Australia, National Health and Medical Research Council, Australian Research Council and VicHealth</span></em></p>The evidence is clear: a tax on sugary drinks would reduce consumption. All that’s needed is political leadership that prioritises health above the profits.Gary Sacks, Associate Professor, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1606212021-05-16T07:51:45Z2021-05-16T07:51:45ZSouth Africa must ban sugary drinks sales in schools. Self regulation is failing<figure><img src="https://images.theconversation.com/files/400513/original/file-20210513-21-1bdlcs8.jpg?ixlib=rb-1.1.0&rect=418%2C23%2C1083%2C812&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">White River Primary school in South Africa, sponsored by Coca Cola.</span> <span class="attribution"><span class="source">Roo Reynolds/Flickr</span></span></figcaption></figure><p>In 2017, Coca-Cola Beverages South Africa voluntarily <a href="https://www.timeslive.co.za/sunday-times/news/2017-08-12-how-coke-is-keeping-sugar-on-the-school-menu/">announced</a> that it would stop supplying sugary beverages to primary school outlets. The company also pledged to remove all branding and advertising from schools. The announcement took the form of a letter noting that that Coca-Cola Beverages wanted to play “an active role in addressing rising obesity rates in South Africa, especially among children”. </p>
<p>Childhood obesity is a serious and growing problem is South Africa. More than <a href="https://www.samrc.ac.za/sites/default/files/attachments/2019-01-29/SADHS2016KeyFindings.pdf">13% of children</a> are either obese or overweight. The consumption of liquid sugar is particularly harmful because it is absorbed so quickly into the bloodstream. Not surprisingly, sugary drinks and their marketing has been linked to obesity especially among children. Just a single sugary beverage per day increases that child’s chance of overweight by 55%. Similarly, once they become an overweight teen, there is a 70% chance they will not be able to lose the weight.</p>
<p>The food environment in schools plays a significant role in increasing access to sugary drinks. Children spend a lot of time in school during their developmentally important periods. Among others, the types of food and beverages children are exposed to at school influence their eating patterns and food preferences. </p>
<p>This is a concern for South Africans as children are exposed to <a href="https://pubmed.ncbi.nlm.nih.gov/26513442/">aggressive marketing</a> and <a href="http://www.sajcn.co.za/index.php/SAJCN/article/view/528">unhealthy foods and beverages</a> at schools. Of particular concern is learners’ excessive sugary drinks consumption. An average grade 4 learner (10-year-old) has around one to two <a href="https://www.ajol.info/index.php/jfecs/article/view/53995">sugary drinks per day</a>, with each soft drink containing up to nine teaspoons of sugar. </p>
<p>Obesity prevention efforts are clearly needed in schools. But what should these efforts entail? Our <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1898130">new research</a> shows that voluntary actions by industry are not part of the recipe. </p>
<p>The aim of our research was to see what drinks were available at schools after Coca-Cola’s announcement. Our audit showed that the company’s brands remained available in most of the schools. Our study highlights that ceding regulation to industry is risky; government regulations and legislation are needed.</p>
<h2>Tuck shop audit</h2>
<p>We studied the food environment across 105 public primary schools in South Africa’s Gauteng province. Schools were located in both affluent and in poorer areas. This allowed us to see if there were any differences in outcomes based on the socioeconomic status of the school. Fieldworkers visited tuck shops and other food outlets on school premises. They spoke to school staff to find out what was being sold to the children through the school stores or tuck shops. </p>
<p>In general, food consumed at schools can constitute up to <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1898130">20%–30%</a> of learners’ total daily caloric intake. This is either through the government school meal programmes in poorer areas, from the school tuck shops or learners’ lunch boxes brought from home. </p>
<p>Our study showed that two years after Coca-Cola Beverages pledge, carbonated sugary drinks were available in 54% of primary school tuck shops. These drinks were more available in fee-paying schools (86%) than no-fee schools (21%). When researchers looked at the availability of alternative low-calorie products, they found that none of the school tuck shops sold only low-calorie drinks. </p>
<p>Decision makers explained that schools faced challenges such as financing general school maintenance and staff salaries. They felt like they had to make a trade-off between revenue generation and the healthfulness of the products they sold in the tuck shops. We found that Coca-Cola Beverages South Africa is not the sole distributor to school tuck shops. Therefore, even when Coca-Cola Beverages South Africa would not supply sugary beverages, schools stocked their tuck shops through general commercial wholesalers. </p>
<p>When it came to advertising, only some schools reported that the company had done what was promised in the pledge, to remove all branding and advertising from schools. But this was the exception rather than the norm. Nearly one-third (31%) of schools had Coca-Cola branding or advertising on school premises. Much of the branding are billboards with the name of the school. Respondents reported that branding, in particular branded fridges, remained unchanged. </p>
<p>Less than half of the school decision makers interviewed in the study were aware of the pledge. This suggests that they either did not recall the letter or had not seen it. The study also revealed that there was easy access to unhealthy products outside school premises through informal food vendors and nearby stores.</p>
<h2>Recommendations</h2>
<p>Despite the common reliance on self-regulatory measures by commercial food entities there is no evidence to support either their effectiveness or safety, according to policy expert <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62089-3/fulltext">Professor Rob Moodie and colleagues</a>.</p>
<p>A ban on sugary drinks sales and advertising is likely to hold more promise than voluntary actions in improving the diets of school-going children and contribute to obesity prevention efforts among children. There is promising evidence from other developing countries, like <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305159">Chile</a>, where a ban on unhealthy foods and beverages resulted in substantial reduction in sales of such products in schools.</p>
<p>Change must also happen in the wider school community, in line with our constitutional basis in the best interests of the child. </p>
<p>Students, school staff, parents, and tuck shop owners all play a significant role in creating a healthier food environment at schools. Making a change at the tuck shop might feel risky but small changes such as banning sugary drinks are an excellent start. This already happening across the globe. </p>
<p>Lastly, it is important that these changes are communicated with the wider school community. The health benefits of the changes should be explained, emphasising the positive impact on students’ nutrition, well-being and school performance. Learners should be able to question what they can buy at school tuck shops or are served for lunch. Every school child in South Africa is entitled to an easy and healthy dietary choice on a daily basis.</p><img src="https://counter.theconversation.com/content/160621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Agnes Erzse receives funding from from the SA MRC, IDRC Canada, the UK National Institute for Health Research through the University of Cambridge and Bloomberg Philanthropies, through UNC Chapel Hill.</span></em></p><p class="fine-print"><em><span>Karen Hofman receives funding from the SA MRC, IDRC Canada, the UK National Institute for Health Research through the University of Cambridge and Bloomberg Philanthropies, through UNC Chapel Hill.</span></em></p><p class="fine-print"><em><span>Nicola Christofides receives funding from European Research Council, UKRI. </span></em></p>A ban on sugary drinks sale and advertisements in schools is likely to hold more promise in improving the diets of children and help prevent obesity in children than voluntary actions.Agnes Erzse, Researcher, SAMRC/Centre for Health Economics and Decision Science- PRICELESS SA, University of the WitwatersrandKaren Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandNicola Christofides, Associate Professor, School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1562302021-04-20T12:33:27Z2021-04-20T12:33:27ZAfrican countries must consider legal challenges to sugar taxes before pursuing policies<figure><img src="https://images.theconversation.com/files/388523/original/file-20210309-23-1lnr2vd.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>Sales of unhealthy foods and beverages in sub-Saharan Africa are skyrocketing. This is leading to an <a href="https://www.sciencedirect.com/science/article/pii/S2211912420301206">increase in obesity related conditons</a> such as diabetes, hypertension and cardiovascular disease. </p>
<p>These diseases are projected to become <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30370-5/fulltext">the leading cause of death in sub-Saharan Africa by 2030</a>, overtaking communicable diseases like HIV and TB. The economic cost of noncommunicable diseases is immense. They result in significant disability, and can be very expensive to treat. In South Africa, the medical cost of diabetes was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012049/">R2.7 billion in 2018</a>. </p>
<p>But noncommunicable diseases are preventable. The economic and societal impact can be mitigated if governments take decisive action to reduce the availability of harmful products such as unhealthy food, alcohol and tobacco.</p>
<p>Sugar-sweetened beverages are among the most harmful food products to consumers. This is because <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043276012001191?casa_token=mkh_7xDvoqUAAAAA:54Fjyj7MH3XZAsDWKBdWzLq9GvUIYEkYtrL1ruRSrlcE5nf3Bqf_OfhP7aenNpumeNMGtHtNfZE">liquid sugar is especially toxic</a> and these drinks have no nutritional value.</p>
<p>One of the key ways to address the growing public health impact of sugary drinks is by introducing laws, policies and regulations. These measures could limit the availability of unhealthy products and make it easier to encourage people to eat healthy food. But they must be implemented as a combined effort. </p>
<p>There are a number of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12580">proven interventions</a> to reduce the consumption of sugary drinks. These include limiting portion sizes, banning them from schools and checkout isles of supermarkets and taxing sugar-sweetened drinks. </p>
<p>But these measures have been challenged legally and by other means by the companies that produce and sell sugary drinks. </p>
<p>In 2012, then New York City mayor Michael Bloomberg introduced a regulation limiting the portion sizes of sugar-sweetened drinks sold around the city. The beverage industry and retailers <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302862">challenged this decision in court</a> and the policy was rolled back. South Africa’s efforts to introduce a tax on sugar-sweetened beverages <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00647-3">faced threats of legal challenges</a>. These were based on a range of technicalities from a lack of public participation to challenging the purpose of the tax. In this case, the objections only delayed the tax rather than stopping it. </p>
<p>Even if these law suits are unsuccessful, they can have a chilling effect on other actions to prevent noncommunicable diseases. Legal challenges to government efforts to address the availability of unhealthy food and drinks can seriously undermine public health.</p>
<p>This is why countries must carefully consider the legal feasibility of an intervention before deciding how to implement it. We <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1884358">developed</a> a way in which countries can consider doing this. It involves an assessment of the potential legal barriers to, and as well as the facilitators of, the proposed intervention.</p>
<h2>The landscape</h2>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1884358">study</a> looked at the legal feasibility of introducing a tax on sugar-sweetened beverages in seven sub-Saharan African countries: Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda, and Zambia. We looked at four different types of sugary drinks taxes that had been introduced around the world and whether these could be introduced in each of these countries.</p>
<p>We assessed each country’s legal barriers and facilitators. These included their legal and taxation regimes. We also examined broader regional agreements and the infrastructure needed to implement such a tax. </p>
<p>We considered <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y">taxes implemented in various countries around the world</a> and chose to evaluate the four taxes adopted in Mexico, Colombia, the UK and South Africa under this study. The tax introduced in Mexico added a fixed amount on each litre of soft drink. The taxes in South Africa and the United Kingdom link the amount of tax payable to the sugar content of a drink. And Colombia decided to remove a value added tax exemption from sugar-sweetened beverages. With the exception of Colombia’s approach, most of these taxes are introduced as an excise tax.</p>
<p>Our research showed that all seven sub-Saharan African countries had existing excise tax legislation. And five countries already taxed sugar-sweetened beverages. However, these existing taxes worked to generate revenue for governments rather than improve public health as the taxes did not differentiate between sugary and non-sugary drinks. For example, Rwanda had a tax of 39% on carbonated beverages but sugary drinks remained a cheap beverage option.</p>
<p>In addition, countries have an obligation to introduce measures to protect the health of their citizens. These obligations are set out in treaties like the <a href="https://www.achpr.org/legalinstruments/detail?id=49">African Charter on Human and Peoples’ Rights</a> and domestic constitutions which contain rights to nutritious food or health. </p>
<p>Our research also showed that there were existing laws that could be used as a foundation to adopt a sugar-sweetened beverage tax to improve public health. For example, <a href="https://www.theguardian.com/global-development/2018/oct/26/tax-on-drinks-to-raise-funds-for-hiv-treatment-in-uganda">Uganda</a> had a dedicated HIV fund which was funded entirely by a 2% levy on drinks (including soft drinks and bottled water). Both <a href="https://www.kilimo.go.tz/index.php/en/stakeholders/view/sugar-board-of-tanzania-sbt">Tanzania</a> and <a href="http://kenyalaw.org/kl/fileadmin/pdfdownloads/bills/2019/TheSugarBill_2019.pdf">Kenya</a> had an agricultural levy on sugar, the proceeds of which were used to support sugar farmers. </p>
<p>The existence of supportive legal frameworks such as human rights could also be used to defend against potential challenges to a public health measure like this. </p>
<p>The introduction of taxes on sugar-sweetened beverages in <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/did-high-sugarsweetened-beverage-purchasers-respond-differently-to-the-excise-tax-on-sugarsweetened-beverages-in-mexico/37DBC66A6F1E19F74942888814EB1EA3">Mexico</a> and <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/abs/assessing-sugarsweetened-beverage-intakes-added-sugar-intakes-and-bmi-before-and-after-the-implementation-of-a-sugarsweetened-beverage-tax-in-south-africa/050AA9D1D8F9B12026C0F7836D1B4F09">South Africa</a> resulted in the reduced consumption of sugar and sugary drinks consumption within a year or two after the implementation of the tax. These reductions can lead to significant <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/assessing-sugarsweetened-beverage-intakes-added-sugar-intakes-and-bmi-before-and-after-the-implementation-of-a-sugarsweetened-beverage-tax-in-south-africa/050AA9D1D8F9B12026C0F7836D1B4F09">health benefits</a>, particularly in people who consume a lot of sugary drinks. In addition, these taxes are a particularly good intervention because they can help governments generate additional tax revenues. </p>
<h2>Looking ahead</h2>
<p>Our research shows that sugar-sweetened beverage taxation in the seven countries is legally feasible. Existing laws can provide a strong starting point for the introduction of a sugar-sweetened beverage tax. In addition, the adoption of such a tax is a way for governments to meet their human rights obligations without having to worry about legal challenges undermining the intervention.</p>
<p>Legal feasibility and the health impact of these interventions are only one part in the complex political economy of adopting noncommunicable disease prevention interventions. Research has shown that <a href="https://www.tandfonline.com/doi/abs/10.1080/23288604.2019.1669122">the political environment</a> and <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00647-3">industry pushback</a> against measures like sugar taxation are also important hurdles that need to be overcome. </p>
<p>Governments must take urgent action to prevent noncommunicable diseases from becoming an uncontrollable epidemic in sub-Saharan Africa. Sugar-sweetened beverage taxation offers a potential solution.</p><img src="https://counter.theconversation.com/content/156230/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Safura Abdool Karim is supported by the South African Medical Research Council Centre for Health Economics and Decision Science - PRICELESS SA. The research referenced in this article was supported by the International Development Research Centre, Canada.</span></em></p><p class="fine-print"><em><span>Karen Hofman is supported by the South African Medical Research Council Centre for Health Economics and Decision Science - PRICELESS SA. The research referenced in this article was supported by the International Development Research Centre, Canada.</span></em></p>Governments must take urgent action to prevent noncommunicable diseases from becoming an uncontrollable epidemic in sub-Saharan Africa. Sugar-sweetened beverage taxation offers a potential solution.Safura Abdool Karim, Senior researcher, University of the WitwatersrandKaren Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1562162021-04-20T12:32:08Z2021-04-20T12:32:08ZWhy African countries need reliable local data on sugary drinks taxes<figure><img src="https://images.theconversation.com/files/388205/original/file-20210308-18-779b17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Diets in sub-Saharan Africa are <a href="https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.12433">changing</a> as more countries advance from low-income to middle-income status. People’s eating habits are shifting from food rich in starchy staples, vegetables and fruits to a more <a href="https://theconversation.com/whats-driving-sub-saharan-africas-malnutrition-problem-55579">westernised diet</a> high in sugar, saturated fats and oils. This shift to unhealthy foods is <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">fuelling</a> obesity related chronic, noncommunicable conditions such as heart disease, diabetes and cancer.</p>
<p>Preventive measures are more critical than ever to curtail this tsunami that is overwhelming health systems.</p>
<p>One area that must adjust is the food and beverage sector in sub-Saharan Africa. The processed food industry is promoting the region as a <a href="https://www.mdpi.com/2071-1050/11/16/4306/htm">growth market</a> for its products. </p>
<p>To discourage consumption and reduce health risks, an increasing number of low- and middle-income countries have imposed <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6">taxes on sugar-sweetened drinks</a>. Across the globe and especially in <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1231">Latin America</a> and the <a href="https://www.sciencedirect.com/science/article/pii/S0091743517302608?via%3Dihub">Caribbean</a>, taxing sugary drinks to reduce consumption has been effective.</p>
<p>The World Health Organisation (WHO) has <a href="https://africa-health.com/news/world-health-organization-wants-sugar-taxes/">called on</a> African governments to follow this example, and to ease the burden of noncommunicable diseases. </p>
<p>In <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">2015</a>, a WHO panel of public health experts found that: </p>
<blockquote>
<p>appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption, especially if aimed at raising the retail price by 20% or more. </p>
</blockquote>
<p>Some African countries such as South Africa, Botswana and Zambia already tax sugary drinks. But others have been slow to act. The <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">WHO</a> attributes this, in part, to evidence gaps. </p>
<p>Credible local data are essential to determine what taxes can and cannot achieve. </p>
<p>We wanted to get an understanding of what data are available to support the design, implementation, monitoring and evaluation of a sugary drinks tax. We focused on seven sub-Saharan African countries: Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda, and Zambia. These economies are growing and their marketing industries are low-cost. Regulation of unhealthy commodities is also weak. </p>
<p>In combination, these factors represent a growth opportunity for the industry. They will also fuel diet-related noncommunicable diseases.</p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2020.1871189">research</a> highlighted the urgent need for new indicators on unhealthy diets, including sugary drinks consumption and purchase patterns. Without this evidence, countries might underestimate the consumption figures. They might then miss the potential of sugar-sweetened drinks taxation as a public health intervention.</p>
<h2>Our research</h2>
<p>We interviewed stakeholders such as representatives from government agencies, including those in health, commerce, development, agriculture, education and academia. All individuals underscored the importance of local evidence on sugary drinks consumption and purchasing behaviours, as well as fiscal evidence to compare the cost and benefits of a tax. This is because policymakers need to take into account evidence for coherent economic arguments to discuss sugar-sweetened drinks taxes in policy circles.</p>
<p>The potential health benefits, the revenue of such a tax, as well as the monitoring and evaluation of its implementation, requires appropriate baseline data at the outset particularly across income levels, and age groups. </p>
<p>Our study highlights that such information is missing in all seven countries.</p>
<p>We looked at a range of publicly available data sources to establish the rate of sugary drinks consumption and the impact on people’s health. </p>
<p>We found that national survey data does not adequately track either the intake of sugar-sweetened drinks, or household spending. Fiscal data is lacking regarding sugary drinks tax revenue, value added tax from sugary beverage sales, and the corporate income tax and customs duty revenue.</p>
<p>Accurate information on the soft drinks industry was not easily accessed either. Unlike in countries such as Mexico, it was difficult to find information on a number of fronts. The number of companies in industry sectors, beverage industry forecasts, drinks prices, package sizes, number of low- or no-calorie beverages, and sugar content were unavailable. </p>
<p>Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages. But only Zambia had a differential sugar-sweetened beverages tax – 3% on imported beverages and 0.5% on local drinks. Botswana recently introduced a tax that is very similar to the health promotion levy in South Africa.</p>
<h2>Going forward</h2>
<p>Timely, easily understood, concise, and locally relevant evidence is needed to inform policy development on sugary drinks. The relevant data are drawn from multiple sectors. Cross-sector collaboration is, therefore, needed. </p>
<p>Indicators to measure sugar-sweetened drinks and added sugar consumption should be developed. These must be included in current data collection tools such as national income dynamics studies. This would ensure monitoring and evaluation of taxation. </p>
<p>There’s no consensus on how best to capture data for new indicators. But a useful point of departure would be to complement existing data sources. These include population-based surveys that ask questions related to sugary drinks taxation. This would lead to improvement in tracking the intake of sweet drinks, and the effectiveness of taxation.</p>
<p>Establishing robust, accurate baseline data to inform evidence could enable governments to accelerate political and public support for sugar-sweetened beverage taxation and related policies. Finally, greater transparency of industry data is essential.</p><img src="https://counter.theconversation.com/content/156216/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Agnes Erzse receives funding from the South African Medical Research Council/Centre for Health Economics and Decision Science PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health
Sciences, Johannesburg South Africa (D1305910-03). The research was supported by the International Development Research Center grant (#108648-001)</span></em></p><p class="fine-print"><em><span>Karen Hofman is supported by the South African Medical Research Council Centre for Health Economics and Decision Science - PRICELESS SA. The research referenced in this article was supported by the International Development Research Centre, Canada.</span></em></p>Without reliable, local and timely data, countries will miss the potential of sugar-sweetened beverage taxation as a public health intervention.Agnes Erzse, Researcher, SAMRC/Centre for Health Economics and Decision Science- PRICELESS SA, University of the WitwatersrandKaren Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag: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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Read more:
<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/1563162021-04-20T12:27:18Z2021-04-20T12:27:18ZZambia must find a way to balance the economy and public health in tax policy<figure><img src="https://images.theconversation.com/files/394740/original/file-20210413-17-9xp7jr.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>The burden of noncommunicable diseases is <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30374-2/fulltext">growing rapidly</a> across sub-Saharan Africa. The conditions, which include obesity and diabetes, are now <a href="https://www.who.int/nmh/countries/2018/zmb_en.pdf">leading causes</a> of premature deaths. In Zambia, noncommunicable diseases account for <a href="https://www.who.int/nmh/countries/2018/zmb_en.pdf">29% of all deaths</a>.</p>
<p>The consumption of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0140673612620893">unhealthy commodities</a> – tobacco, alcohol and ultra-processed foods high in sugar, salt and fats – is a major risk factor for these conditions. </p>
<p>To regulate the availability of unhealthy commodities, the World Health Organisation (WHO) recommends cost-effective, evidence-based interventions. One such measure is a <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">tax on sugar-sweetened beverages</a>. Sweetened beverages are associated with a number of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12868">health complications</a>. These include an increased risk of <a href="https://www.bmj.com/content/351/bmj.h3576">type 2 diabetes</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/26869455/">cardiovascular diseases</a> and other obesity‐related diseases.</p>
<p>The aim of such a tax is to discourage people from buying these drinks. </p>
<p>Zambia is one of the African countries that has acted to regulate the environment for products linked to obesity. In January 2019 the country introduced an excise tax on all non-alcoholic beverages except water. A <a href="https://extranet.who.int/nutrition/gina/sites/default/filesstore/ZMB%202018%20Customs%20and%20Excise%20%28amendment%29%20%20Act%20No.%2019%20of%202018.pdf">tax rate</a> of K0.30 (US$ 0.02) per litre was levied. This 3% tax is well below the <a href="https://gh.bmj.com/content/bmjgh/5/4/e001968.full.pdf">recommended rate</a> of 20% required to reduce noncommunicable disease risk factors like obesity. Because of the low rate, health sector stakeholders are suggesting that the tax no longer focuses on public health. Instead, it’s a general source of government revenue. </p>
<p>In our recent <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1872172">study,</a> my colleagues and I looked for opportunities to strengthen this tax policy in Zambia. Our focus was on sugar-sweetened beverage taxation. We reviewed policy documents and spoke to nutrition advocates, industry representatives and policymakers. We wanted to understand the context in which policies about nutrition-related diseases are developed. We also wanted to explore the potential use of revenue from tax on sugary drinks to support improved nutrition.</p>
<p>Our findings showed tension between the government’s economic and public health priorities. The government has <a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-017-0195-7">intentions of regulating</a> production of harmful food products like sugar-sweetened beverages. But it also <a href="https://www.mcti.gov.zm/?page_id=5176">commits to growing the economy</a> by investment in the manufacturing sector, which includes the food and beverage sub-sector. </p>
<p>This has prevented stronger fiscal measures to address noncommunicable diseases related to nutrition. But we believe the tension need not hurt the public health objectives. There are opportunities to strengthen existing taxation of sugary drinks by ensuring policies take local economic context into account.</p>
<h2>Our research</h2>
<p>The policy <a href="https://extranet.who.int/ncdccs/Data/ZMB_B3_NCDs%20Strategic%20plan.pdf">documents</a> we <a href="https://www.mndp.gov.zm/wp-content/uploads/2018/05/7NDP.pdf">reviewed</a> and stakeholder interviews we conducted recognised the increasing problem of noncommunicable diseases in Zambia. </p>
<p>The diseases were linked to lifestyle factors such as physical inactivity and unhealthy diet. But none of the policies we reviewed identified sugary beverages as a driver of noncommunicable diseases in Zambia. </p>
<p>Our interviews also highlighted existing misperceptions. The people we interviewed linked affluence to sugary drinks consumption. They believed wealthier populations were more affected by nutrition-related diseases. But <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-465">research suggests</a> it’s poorer populations who tend to consume more unhealthy food. Unhealthy foods, including processed foods high in salt, fat and sugar, are cheaper than healthier food options but have attracted high status. </p>
<p>Nutrition advocates and government representatives suggested that the lack of diversity in people’s diets could be a contributor to the rise of noncommunicable diseases. Maize porridge – <em>nshima</em> – is a staple in the country and is consumed several times a day. But there’s a lack of evidence in this regard. </p>
<p>Policymakers felt the government was well prepared to address the health problem. They pointed to policies such as the strategic plan for nutrition-related noncommunicable diseases and related <a href="https://extranet.who.int/ncdccs/Data/ZMB_B3_NCDs%20Strategic%20plan.pdf">risk factors</a> as an example. The <a href="https://www.lusakatimes.com/2019/02/02/exercise-is-best-health-practice-president-lungu/">president’s active engagement</a> in promoting healthy lifestyles in mainstream media was seen as good leadership. </p>
<p>In contrast, respondents representing civil society felt that the current leadership and policies were insufficient. Marketing of unhealthy food products remained unregulated and nutrition programmes were poorly funded. They also felt the sugar-sweetened beverage tax was inadequate to curb consumption and hence noncommunicable diseases. </p>
<p>The sugary drinks tax in Zambia was initiated and championed by the Ministry of Health. Initially, a tax rate of 20% was proposed. But this met strong pushback from the government’s economic sector and industry stakeholders. They argued this would contribute to a high cost of doing business. Industry <a href="http://zam.co.zm/download/zam-submission-proposed-regulatory-reform-to-improve-nutrition/">attempted</a> to discredit evidence supporting the tax. Some suggested that the Zambian government was bowing to international pressure without considering the implication of the tax in the domestic context. Such strong lobbying against the tax likely contributed to the low rate of 3% that was eventually adopted.</p>
<p>Respondents suggested that revenues from the tax should finance nutrition and noncommunicable disease prevention programmes. These would include health promotion and education, regulation of the marketing of unhealthy foods, improved food labelling, and incentives for production of healthy foods. </p>
<p>These suggestions reflected a perception among all respondents that the population was largely unaware of causes, prevention and impact of nutrition related noncommunicable diseases. Therefore, raising awareness should be an immediate priority for Zambia.</p>
<h2>Way forward</h2>
<p>Our findings show that there is an opportunity to strengthen policies addressing noncommunicable diseases in African countries through measures like sugar-sweetened beverage taxes. But policy measures should be contextualised to the needs of the country. The priority of most African governments is economic growth. This is evident in policies that encourage growth of industries that produce unhealthy commodities. This context should not be ignored as it bears on the success of policy measures that protect population health. </p>
<p>A differential tax that distinguishes between international and local producers and manufacturers may be a feasible starting point to balance economic interest with public health objectives.</p>
<p>Taxation could also support public health by providing subsidies for fruit and vegetables, or the provision of safe drinking water. To achieve this, the revenues from the tax could be earmarked for health promotion.</p>
<p>Health problems have their origins and consequently solutions outside the health sector. This is why consultation must expand beyond the health sector during the development of policies addressing noncommunicable diseases. </p>
<p>Such consultation will go a long way to improve policy coherence between the health and economic sectors of governments. Policy measures should be contextualised to strike a balance between public health and the economic needs of countries.</p><img src="https://counter.theconversation.com/content/156316/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mulenga Mary Mukanu, received support for this work from International Development Research Centre, Ottawa
Canada under grant number 108648-001. </span></em></p>Tension between the government’s economic and public health priorities is preventing stronger fiscal measures to address nutrition-related noncommunicable diseases.Mulenga Mary Mukanu,, PhD Candidates, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1579082021-04-20T08:08:01Z2021-04-20T08:08:01ZKenya doesn’t have a stand-alone tax on sugary drinks: we set out to find out why<figure><img src="https://images.theconversation.com/files/395266/original/file-20210415-20-r25nse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The consumption of a lot of soft drinks is linked to increased obesity. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Kenya is <a href="https://www.health.go.ke/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">experiencing a rise</a> in obesity. Overweight and obesity among women increased from 25% in 2008 to 33% in 2014. An estimated one in four Kenyan urban children are <a href="https://www.dhsprogram.com/pubs/pdf/sr227/sr227.pdf">overweight or obese</a>. At the same time there has been a rise in associated <a href="https://globalnutritionreport.org/resources/nutrition-profiles/?country-search=kenya">noncommunicable diseases</a>. These include diabetes, cardiovascular diseases and cancer. Noncommunicable diseases now account for over <a href="https://www.health.go.ke/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">50% of hospital admissions</a> in the country.</p>
<p>Globally, the rise in noncommunicable diseases has been attributed to the growing consumption of unhealthy foods such as sugar-sweetened beverages. Between 2018 and 2019 Kenya registered a 30% spike in <a href="https://apps.fas.usda.gov/newgainapi/api/report/downloadreportbyfilename?filename=Sugar%20Annual_Nairobi_Kenya_4-12-2018.pdf">sugar production</a> and an <a href="http://www.parliament.go.ke/sites/default/files/2019-08/Report%20on%20the%20Crisis%20Facing%20the%20Sugar%20Industry%20in%20Kenya%20%28%20Annexures%29.pdf">increase</a> in sugar consumption from the growth of retail, industrial and food service sectors. </p>
<p>To control the rising burden of obesity and noncommunicable diseases the World Health Organisation (WHO) <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">recommends</a> a tax on sugar-sweetened beverages. It views such taxes as a population-level, cost-effective measure to discourage consumption of sugar-sweetened beverages. </p>
<p>The approach has been widely used in several countries including South Africa. However, to date, Kenya has no standalone sugar-sweetened beverage tax policy.</p>
<p>We undertook <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1902659">research</a> into the possibility of implementing a sugar-sweetened beverage tax in Kenya. </p>
<p>The study entailed a desk review of existing evidence on noncommunicable diseases and sugar-sweetened beverages. We also conducted interviews with a wide range of experts to explore the policy and political context as well as the enablers of and barriers to such a policy.</p>
<p>We identified a number of barriers to adopting a tax on sugary drinks in Kenya. These included limited evidence on sugar-sweetened beverages as a risk factor for noncommunicable diseases in Kenya. We also found industry interference in the development of sugar-sweetened beverage taxation policy. </p>
<p>But we also found that existing policies provided an opportunity to pursue a sugar tax in the country. These include the <a href="http://publications.universalhealth2030.org/uploads/kenya_health_policy_2014_to_2030.pdf">Kenya Health Policy</a> and the <a href="https://www.who.int/nmh/ncd-task-force/kenya-strategy-ncds-2015-2020.pdf?ua=1">National Strategy for Control and Prevention of Noncommunicable diseases</a>. </p>
<h2>Barriers</h2>
<p>A number of factors accounted for the fact that Kenya hasn’t pursued a tax on sugar-sweetened beverages.</p>
<p>The first was a dearth of up-to-date publicly available information on sugary drinks sales and consumption in Kenya. Data are essential to guide the decisions and process of development and adoption of a stand alone sugar-sweetened beverage tax. </p>
<p>Interviewees also cited lack of information in the general population about sugar-sweetened beverages and how they affect health. They attested to the fact that tobacco and alcohol are widely recognised risk factors for noncommunicable diseases. Not so with sugar-sweetened beverages.</p>
<blockquote>
<p>An important barrier when we are dealing with sugar-sweetened beverages is the fact that the public does not appreciate that this is a problem. What do respectable old men and women in the village, church elders, take when they go for a meeting? It is tea, Coca-Cola, Sprite, Fanta. I think it presents a subtle challenge that we don’t have when we are dealing with tobacco or alcohol. Nobody argues about the adverse consequences of tobacco or of alcohol.</p>
</blockquote>
<p>A second barrier we identified was that government ministries held different and sometimes opposing interests. </p>
<p>For instance, the ministry of health was interested in improving health and discouraging the trade, production and marketing of sugary drinks. But the ministry of industry, trade and cooperatives promoted the sugar and food processing industries as major revenue for government. </p>
<p>Our key informants felt that these opposing priorities might get in the way of a sugar-sweetened beverage taxation policy being developed. </p>
<p>A third factor we identified was industry lobbying against sweet drinks taxation. The sugar-sweetened beverage companies were described by key informants as having major influence over government decision making. This was because of the power they wielded in terms of their operations, and their contribution to the government revenues. They also use industry alliances and formations to fight sugar-sweetened beverage taxes, which may overwhelm an under-resourced government like Kenya’s. </p>
<p>As one interviewee put it: </p>
<blockquote>
<p>… unfortunately, there’s a lot of industry interference with policy (on sugary drinks). This is a big industry; very big in terms of capital and also in terms of influence. They pay a lot of tax to government and they have a lot of leverage … An industry like that of course has a lot of policy interference because they have big money they can compete with us.</p>
</blockquote>
<p>Kenya does charge an excise tax on all soft drinks of 10 Kenya shillings (0.10 USD) per litre. This includes sugar-sweetened beverages. And in <a href="http://kenyalaw.org/kl/fileadmin/pdfdownloads/bills/2018/FinanceBill__2018.pdf">2018</a> an excise tax of 20 shillings (0.20 USD) per kilogram was imposed on sugar confectionery and chocolate. </p>
<p>But these taxes were introduced as a revenue generation strategy, not as a means to manage noncommunicable diseases. They are likely to have only a minimal impact on the consumption of sugary drinks.</p>
<h2>Going forward</h2>
<p>We made a number of recommendations on how a sugar-sweetened beverage tax could be developed and implemented in Kenya.</p>
<p>First, public and policymaker education is critical to challenge the prevailing attitudes to sugary drinks.</p>
<p>Second, strategies to develop industrial growth should be critically examined to understand how they could undermine the government’s commitment to addressing noncommunicable diseases. This will require wide stakeholder engagement beyond the ministry of health in policy development.</p>
<p>Third, civil society needs to be involved in sustained advocacy to ensure that Kenyans understand the issues at hand.</p>
<p>And more research evidence is needed to support an explicit sugar-sweetened beverage taxation policy. Kenya also needs to gather local and regional or international evidence to inform and guide its decisions in the development and adoption of a standalone tax on sugary drinks.</p><img src="https://counter.theconversation.com/content/157908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work was carried out with support from the International Development Research Centre (IDRC),Ottawa Canada (grant number 108648-001)</span></em></p><p class="fine-print"><em><span>Gershim Asiki 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>Between 2018 and 2019 Kenya registered a 30% spike in sugar production and an increase in sugar consumption.Milka Wanjohi, Research officer, African Population and Health Research CenterGershim Asiki, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1551082021-02-21T12:05:53Z2021-02-21T12:05:53ZA sin tax on sugary drinks unfairly targets Indigenous communities instead of improving health<figure><img src="https://images.theconversation.com/files/385316/original/file-20210219-15-2hg8nd.jpg?ixlib=rb-1.1.0&rect=99%2C46%2C3941%2C3122&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A water bottle sits on the table in front of Chief and NDP candidate Rudy Turtle during a visit by NDP Leader Jagmeet Singh on Oct. 5, 2019 on the Grassy Narrows First Nation, where industrial mercury poisoning in its water system has seriously affected the health of the community.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span></figcaption></figure><p>“Sin taxes” are a tried, <a href="https://knowledge.wharton.upenn.edu/article/do-sin-taxes-really-change-consumer-behavior/">although not necessarily true</a>, strategy for reducing harm connected to alcohol and tobacco. Calls for a tax on sugar-sweetened beverages are supported by a large body of evidence linking weight gain and Type 2 diabetes, to excess consumption of these drinks. <a href="https://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf?sequence=1&isAllowed=y">This response is supported by the World Health Organization</a>, among others, <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/media-centre/the-health-and-economic-impact-of-a-sugary-drink-tax-in-canada-summary.ashx">to offset negative health and economic effects</a>. </p>
<p>The <a href="https://greenparty.mb.ca/news/manitoba-greens-sugar-tax-proposal-would-save-36-million-in-health-care-costs/">idea of taxing sugar-sweetened beverages</a> has <a href="https://www.cbc.ca/news/politics/liberals-ontario-soda-tax-proposal-federal-election-campaign-katie-simpson-1.5136724">caught the attention of political leaders</a> <a href="https://www.fin.gov.nt.ca/en/services/have-your-say-proposed-nwt-sugar-sweetened-drinks-tax">in Canada</a>, too. However, this paternalistic “we know best” approach ignores the most obvious needs and rights of Indigenous Peoples. Rather than seeing the harms of colonization to Indigenous Peoples, governments are fixating on how to tax the Coke in their hands. </p>
<p>Imposing a sugary beverage tax on Indigenous consumers would <a href="https://www.economist.com/the-economist-explains/2018/08/10/do-sin-taxes-work">be unethical</a>, contravene tax law and undermine Indigenous rights to self-determination. Even the <a href="https://www.cbc.ca/news/canada/manitoba/indigenous-forced-labour-sugar-beet-farms-1.4165272">production of sugar in Canada</a> has exploited Indigenous people, who were used essentially as forced labour. </p>
<h2>Health and mental health gaps</h2>
<p>The connection between lack of employment, education and family supports, to poorer health outcomes <a href="https://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Full-Report-FPSCT-Updated.pdf">is well documented</a>. For Indigenous peoples, who often occupy the worst end of wellness measures, this is directly connected to the legacy of colonization. </p>
<p>Moreover, the health gap is profound and getting worse. <a href="http://mchp-appserv.cpe.umanitoba.ca/reference/FN_Report_web.pdf">The Manitoba Centre for Health Policy</a> found the life expectancy gap between First Nations persons and all other Manitobans has widened to 11 years from eight years since 2002. </p>
<p>It comes as no surprise then that Indigenous Peoples also experience diabetes at much higher rates. In Canada, treating diabetes <a href="https://www.diabetes.ca/media-room/press-releases/new-data-shows-diabetes-rates-and-economic-burden-on-families-continue-to-rise-in-ontario--">costs upwards of $30 billion per year</a>. It seems unlikely that a tax on sugary drinks can set this crisis right.</p>
<figure class="align-center ">
<img alt="Close-up of an Indigenous woman with grey hair in a blue shirt" src="https://images.theconversation.com/files/385307/original/file-20210219-21-kmf6x0.jpg?ixlib=rb-1.1.0&rect=238%2C8%2C2757%2C1985&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/385307/original/file-20210219-21-kmf6x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/385307/original/file-20210219-21-kmf6x0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/385307/original/file-20210219-21-kmf6x0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/385307/original/file-20210219-21-kmf6x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/385307/original/file-20210219-21-kmf6x0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/385307/original/file-20210219-21-kmf6x0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Laura Green, a resident of Shoal Lake 40 First Nation, was photographed while speaking about water and access issues in her community on Feb. 25, 2015. The boil water advisory at Shoal Lake 40 has lasted more than two decades, beginning in 1997.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/John Woods</span></span>
</figcaption>
</figure>
<p>Similarly, for those struggling with addiction, eating disorders or other challenges, adding more tax provides no support for better “lifestyle choices.” There is <a href="https://doi.org/10.1016/j.ypmed.2021.106447">evidence linking adverse childhood experiences</a> and trauma to higher intake of sugar-sweetened beverages both in childhood and later in life, as well as <a href="http://doi.org/10.3390/nu12051485">calls to include sugar-sweetened drinks within addiction models</a>, including for survivors of <a href="https://doi.org/10.1016/j.ypmed.2020.106176">childhood maltreatment</a> who disproportionately use food to cope.</p>
<p>Indigenous Peoples are also more likely to live with <a href="https://www.fnha.ca/what-we-do/mental-wellness-and-substance-use">mental illness and addiction</a>, largely due to <a href="http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/142/2015-04-28-AguiarHalseth-RPT-IntergenTraumaHistory-EN-Web.pdf">intergenerational trauma</a>. This raises ethical questions about taxing addiction or behaviours associated with trauma, particularly in light of its colonial roots.</p>
<h2>Taxes, food and water</h2>
<p>One obvious problem with taxing sugar-sweetened beverage consumption by First Nations persons is their <a href="https://www.canada.ca/en/revenue-agency/services/aboriginal-peoples/indians.html">tax-exempt status</a> for all purchases made on reserves. There is no Canadian tax scheme that can avoid this exemption, thus a tax on sugary beverages has no impact on those who are at highest risk for Type 2 diabetes. With the growing presence of <a href="https://www.ictinc.ca/blog/what-are-urban-reserves">urban reserves</a> in many Canadian cities, buying tax-exempt sugar-sweetened beverages is increasingly easy. </p>
<p>Taxation also doesn’t address <a href="https://theconversation.com/canadas-food-guide-is-easy-to-follow-if-youre-wealthy-or-middle-class-114963">underlying issues of food insecurity</a>, prevalent in communities with high Indigenous populations. In urban areas, the <a href="https://doi.org/10.1186/s12937-019-0488-5">2015 Canadian Community Health Survey</a> found Indigenous populations to have the highest intake of sugar-sweetened beverages of any racial or ethnic group. This often reflects a <a href="https://doi.org/10.3390/ijerph17238818">lack of healthy and affordable food in neighbourhoods</a> with large Indigenous populations.</p>
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Read more:
<a href="https://theconversation.com/mining-push-continues-despite-water-crisis-in-neskantaga-first-nation-and-ontarios-ring-of-fire-150522">Mining push continues despite water crisis in Neskantaga First Nation and Ontario’s Ring of Fire</a>
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<p>Canada’s historic approach to resource development and wildlife management has been to ignore the needs and rights of Indigenous communities. Industry was allowed to pollute water bodies, <a href="https://pulitzercenter.org/projects/generations-activism-grassy-narrows-first-nations-fight-clean-water">including with mercury</a>, and destroy food sources relied upon by Indigenous Peoples. For <a href="https://doi.org/10.1503/cmaj.181617">northern</a>, <a href="http://www.fnfnes.ca/docs/FNFNES_draft_technical_report_Nov_2__2019.pdf">rural, remote</a> and <a href="https://proof.utoronto.ca/wp-content/uploads/2020/03/Household-Food-Insecurity-in-Canada-2017-2018-Full-Reportpdf.pdf">urban populations</a>, food insecurity continues to be a problem. Increasing food prices wouldn’t fix this.</p>
<p>A tax on sugar-sweetened beverages implies that Indigenous Peoples can either make better food choices, or choose to pay the tax. Yet <a href="https://canadians.org/fn-water">safe drinking water</a> and <a href="https://www.rcinet.ca/eye-on-the-arctic/2019/03/29/canada-nutrition-north-food-security-iqaluit-grocery-price/">affordable food</a> are not within reach of many Indigenous Peoples. </p>
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Read more:
<a href="https://theconversation.com/water-crisis-in-first-nations-communities-runs-deeper-than-long-term-drinking-water-advisories-148977">Water crisis in First Nations communities runs deeper than long-term drinking water advisories</a>
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<p>The disconnect here is how taxing sugary drinks will help reduce diabetes and other health problems for this group. There is a serious credibility gap when governments demand consumers pay extra when choices are limited, and then promise tax revenue will be used to benefit their health. Despite promises by the federal government to fix all boil water advisories in five years, <a href="https://globalnews.ca/news/7497223/indigenous-services-minister-says-trudeau-government-wont-end-boil-water-advisories-by-march-2021/">it failed to deliver</a> on this basic human right. </p>
<h2>Shifting responsibility</h2>
<p>The solution, it seems, shifts responsibility for wellness from addressing inequality, to imposing a sugar-sweetened beverage tax on those most affected by poverty and lack of clean water, and for whom <a href="https://theconversation.com/joyce-echaquans-death-how-a-decolonizing-approach-could-help-tackle-racism-in-health-care-148517">racism in health care</a> is a daily reality. By framing the “problem” just the right way, the “solution” is easy to sell to a nation struggling to accept responsibility for the continuing harms of colonization.</p>
<p>As a young nation, Canada signed Treaty agreements to share land and resources. Instead of honouring those promises, Canada enacted the <a href="https://indigenousfoundations.arts.ubc.ca/the_indian_act/"><em>Indian Act</em></a>, essentially stripping First Nations of even the most basic human rights. Since then, Canadian governments have rarely acted in the best interests of Indigenous Peoples. </p>
<p>Today, Canada is considering <a href="https://parl.ca/DocumentViewer/en/43-2/bill/C-15/first-reading">Bill C-15</a> to adopt minimum standards of Indigenous rights as set out in the <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">United Nations Declaration on the Rights of Indigenous Peoples</a>. This includes the right to self determination. Rather than taxing sugar-sweetened beverages, a better solution is to end paternalism and to provide real choices by confronting inequality and racism.</p><img src="https://counter.theconversation.com/content/155108/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Myra J Tait receives funding from Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Natalie Diane Riediger receives funding from Canadian Institutes of Health Research. </span></em></p>A tax on sugar-sweetened beverages may be intended to improve health, but for Indigenous consumers, such a tax would be unethical, contravene tax law and undermine Indigenous rights.Myra J Tait, Assistant Professor, Governance, Law and Management, Athabasca UniversityNatalie Diane Riediger, Assistant Professor of Nutritional Epidemiology, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1310242020-02-27T05:35:20Z2020-02-27T05:35:20ZLet’s ‘declare war on type 2 diabetes’ – Australian of the year James Muecke on why we need to cut back on sugar<figure><img src="https://images.theconversation.com/files/315130/original/file-20200212-187223-qdkwir.jpg?ixlib=rb-1.1.0&rect=35%2C8%2C5955%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/american-donuts-570984256">Shutterstock</a></span></figcaption></figure><p>Humans are physiologically hardwired to love and seek out sweet things. It’s an ancient survival mechanism that evolved to prepare our bodies for periods of fasting when food supplies were scarce. </p>
<p>Like nicotine, alcohol and other drugs, sugar activates the reward system in our brains, resulting in <a href="https://www.ncbi.nlm.nih.gov/pubmed/31125634">the release of the neurotransmitter dopamine</a>. It feels good, so we want to do it again. </p>
<p>It can also give us solace when we’re down and can alleviate stress, as the dopamine hit counters cortisol, a stress hormone which is released during anxious times. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fact-or-fiction-is-sugar-addictive-73340">Fact or fiction – is sugar addictive?</a>
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</em>
</p>
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<p>The problem is, the more sugar we ingest, <a href="https://www.ncbi.nlm.nih.gov/pubmed/31125634">the more we need</a> to make us feel good. It’s a vicious cycle that’s hard to break.</p>
<p>Excessive and sustained sugar consumption increases the risk of developing type 2 diabetes, a metabolic disorder where the body can’t maintain healthy levels of glucose (sugar) in the blood. </p>
<p>Globally, the number of adults with type 2 diabetes, which is related to diet and lifestyle, has <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">quadrupled over the past 40 years</a>. In 2017-18, <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2017-18%7EMain%20Features%7EDiabetes%20mellitus%7E50">one million Australians had type 2 diabetes</a> and many more were at <a href="https://www.diabetesaustralia.com.au/what-is-diabetes">risk of developing the condition</a>. </p>
<p>It’s not impossible to cut down on sugar. Some strategies require change on a personal level, while others must be taken on by industry and governments. </p>
<h2>Personal strategies</h2>
<p>At the personal level, it’s a matter of slowly winding down our addiction. Going cold turkey would be incredibly difficult, given <a href="https://care.diabetesjournals.org/content/37/4/950">75% of our food and drinks have added sugar</a>.</p>
<p>I started omitting the obvious products loaded with sugar – soft drinks, fruit juices, dried fruit, chocolate, candy, ice cream, cakes and sweet biscuits. I stopped sprinkling sugar on my cereal and stirring it into my tea and coffee.</p>
<p>Even these simple strategies gave me <a href="https://theconversation.com/heres-what-happens-to-your-brain-when-you-give-up-sugar-for-lent-37745">withdrawal symptoms</a> such as irritability, headache, sluggish thoughts, and fatigue, which began on the very first day. These symptoms and the cravings were unpleasant but only lasted three days. </p>
<p>Progressing to the next level might include cutting out commercially produced foods that contain excessive amounts of added sugar such as jams, condiments, and most breakfast cereals.</p>
<p>It might also mean cutting out or down on heavily processed products that contain refined carbohydrates such as white flour (white bread, pastries and pasta), white rice, and white potatoes (especially fries and crisps). Such carbs are broken down to glucose in the gut, and are really just another form of sugar consumption.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Is it time to cut back on jams and sugary spreads?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-young-caucasian-man-wearing-casual-1243183228">Shutterstock</a></span>
</figcaption>
</figure>
<p>It helps to be aware of the times we’re consuming sugar out of habit, such as eating a bag of sugary treats at the movies or a block of chocolate in front of the TV, or using sugar as a reward for a job well done. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-sugar-is-so-bad-for-us-why-is-the-sugar-in-fruit-ok-89958">If sugar is so bad for us, why is the sugar in fruit OK?</a>
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<hr>
<p>It’s also important to be aware of those times when we’re using sugar to make us feel better or alleviate stress. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/31125634">brain doesn’t care where it gets its feel-good chemicals</a> from, so try going for a walk, run or cycle, listen to your favourite music playlist, or try doing a good deed instead. </p>
<h2>Government response</h2>
<p>From a public health perspective, the government must play a pivotal role in helping Australians cut down on sugar. </p>
<p>Strategies at the government level should be aimed at accessibility, addition and advertising.</p>
<p>Making sweet products less obvious and accessible in supermarkets, delicatessens, post offices and service stations would be a good start. Moving them away from check-out counters means those reflex purchases are less likely to happen. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&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">Lollies and chocolates should be moved away from supermarket checkouts.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cash-desk-cashier-serving-customers-supermarket-273291662">Shutterstock</a></span>
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<p>Second, we need a levy (or a tax) on products containing high levels of added sugar, particularly on sugar-sweetened drinks. There is <a href="https://theconversation.com/dont-believe-the-myths-taxing-sugary-drinks-makes-us-drink-less-of-it-130694">strong evidence</a> a tax on such drinks would reduce consumption and <a href="https://care.diabetesjournals.org/content/early/2019/09/18/dc19-0734">result in a decline in type 2 diabetes</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-believe-the-myths-taxing-sugary-drinks-makes-us-drink-less-of-it-130694">Don't believe the myths – taxing sugary drinks makes us drink less of it</a>
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<hr>
<p>Third, a more transparent system for labelling of the added sugar content of products should be implemented. The current health star rating system is only voluntary and is in need of reform. </p>
<p>Fourth, advertising time and space for sugary products should be restricted, as we have done for cigarettes, starting with ads targeting children on TV and social media.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Kids shouldn’t be exposed to ads for sugary foods.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-cute-girl-watching-tv-250881613">Shutterstock</a></span>
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</figure>
<p>Fifth, powerful and hard-hitting awareness campaigns should be introduced, as we have done for cigarettes. Who could forget those graphic TV adds of tar being poured over lungs or fat being squeezed out of an artery?</p>
<p>Finally, we need a multi-disciplinary think tank to raise awareness about the health dangers of sugar. Such a body could engage endocrinologists (medical doctors who treat diabetes), public health physicians, neuroscientists, nutritionists, marketers, PR experts, and government representatives to deliver clear and united messages. </p>
<p>The sugar industry and the food and beverage industries will need to be included in discussions about reform, but we can’t let commercial interests stop us from acting. </p>
<p>Type 2 diabetes is a growing epidemic and one of the nation’s biggest health challenges. It’s time for Australia to declare war on type 2 diabetes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/abc-four-corners-five-articles-to-get-you-informed-on-sugar-and-big-sugars-role-in-food-policy-95775">ABC Four Corners: five articles to get you informed on sugar and Big Sugar's role in food policy</a>
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</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/131024/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Muecke 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>We’re hardwired to love sweet things, but too much sugar is leading to an increase in type 2 diabetes. Here’s what individuals and policymakers can do cut our collective sugar intake.James Muecke, Clinical senior lecturer in Ophthalmology and Visual Sciences, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1306942020-01-30T03:52:32Z2020-01-30T03:52:32ZDon’t believe the myths – taxing sugary drinks makes us drink less of it<figure><img src="https://images.theconversation.com/files/312710/original/file-20200130-154354-gk17rc.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C3988%2C2676&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">2020 Australian of the Year James Muecke has called for a tax on sugary drinks – and the evidence is behind him.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/melbourne-vicaustraliaaugust-18th-2018-variety-soft-1417058798">Shuang Li/Shutterstock</a></span></figcaption></figure><p>This year’s Australian of the Year, Dr James Muecke, is an eye specialist with a clear vision. He wants to <a href="https://www.australianoftheyear.org.au/news-and-media/media-releases/article/?id=2020-australian-of-the-year-awards-announced">change the way the world looks at sugar</a> and the debilitating consequences of diabetes, which include blindness. </p>
<p>Muecke is pushing for Scott Morrison’s government to enact a tax on sugary drinks to help make that a reality. </p>
<p>Such a tax would increase the price of soft drinks, juices and other sugary drinks by around 20%. The money raised could be used to fund health promotion programs around the country.</p>
<p>The evidence backing his calls is strong. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-sugary-drinks-tax-could-recoup-some-of-the-costs-of-obesity-while-preventing-it-69052">A sugary drinks tax could recoup some of the costs of obesity while preventing it</a>
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<h2>Taxes on sugary drinks work</h2>
<p><a href="https://www.obesityevidencehub.org.au/collections/prevention/countries-that-have-implemented-taxes-on-sugar-sweetened-beverages-ssbs">Several governments</a> around the world have adopted taxes on sugary drinks in recent years. The evidence is clear: they work.</p>
<p>Last year, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12868">a summary of 17 studies</a> found health taxes on sugary drinks implemented in Berkeley and other places in the United States, Mexico, Chile, France and Spain reduced both purchases and consumption of sugary drinks. </p>
<p>Reliable <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12868">evidence</a> from around the world tells us a 10% tax reduces sugary drink intakes by around 10%.</p>
<p>The United Kingdom soft drink tax has also been making <a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">headlines</a> recently. Since its introduction, the amount of sugar in drinks has decreased by almost <a href="https://www.gov.uk/government/publications/sugar-reduction-progress-between-2015-and-2018">30%</a>, and six out of ten leading drink companies have <a href="https://doi.org/10.1186/s12916-019-1477-4">dropped the sugar content</a> of more than 50% of their drinks.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">Sugary drinks tax is working – now it's time to target cakes, biscuits and snacks</a>
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<p>In Australia, modelling studies have shown a 20% health tax on sugary drinks is likely to <a href="https://doi.org/10.1371/journal.pmed.1002326">save almost A$2 billion in healthcare costs</a> over the lifetime of the population by preventing diet-related diseases like diabetes, heart disease and several cancers. </p>
<p>This is over and above the <a href="https://doi.org/10.1093/eurpub/cky087">cost benefits</a> of preventing dental health issues linked to consumption of sugary drinks.</p>
<p>Most of the health benefits (nearly 50%) would occur among those living in the lowest socioeconomic circumstances. </p>
<p>A 20% health tax on sugary drinks would also <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002326">raise over A$600 million</a> to invest back into the health of Australians. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&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">After sugar taxes are introduced, people tend to switch from sugar drinks to other product lines, such as bottled water and artificially sweetened drinks.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pretty-young-woman-buying-groceries-supermarketmallgrocery-229037452">l i g h t p o e t/Shutterstock</a></span>
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<h2>So what’s the problem?</h2>
<p>The soft drink industry uses <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12639">every trick in the book</a> to try to convince politicians a tax on sugary drinks is bad policy. </p>
<p>Here are our responses to some <a href="https://doi.org/10.1017/S1368980017003330">common arguments against</a> these taxes: </p>
<p><strong>Myth 1: Sugary drink taxes unfairly disadvantage the poor</strong> </p>
<p>It’s true people on lower incomes would feel the pinch from higher prices on sugary drinks. A 20% tax on sugary drinks in Australia would cost people from low socioeconomic households about <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002326">A$35 extra per year</a>. But this is just A$4 <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/impact-of-a-tax-on-sugarsweetened-beverages-according-to-socioeconomic-position-a-systematic-review-of-the-evidence/587CFDC392441741771A93E7F652E222">higher</a> than the cost to the wealthiest households.</p>
<p>Importantly, poorer households are <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/impact-of-a-tax-on-sugarsweetened-beverages-according-to-socioeconomic-position-a-systematic-review-of-the-evidence/587CFDC392441741771A93E7F652E222">likely</a> to get the biggest health benefits and long-term health care savings. </p>
<p>What’s more, the money raised from the tax could be targeted towards reducing health inequalities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">Australian sugary drinks tax could prevent thousands of heart attacks and strokes and save 1,600 lives</a>
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<p><strong>Myth 2: Sugary drink taxes would result in job losses</strong></p>
<p>Multiple studies have shown <a href="https://www.obesityevidencehub.org.au/collections/prevention/arguments-against-an-ssb-tax-in-australia">no job losses</a> resulted from taxes on sugar drinks in <a href="https://doi.org/10.1016/j.ypmed.2017.09.001">Mexico</a> and the <a href="https://doi.org/10.1371/journal.pone.0213218">United States</a>. </p>
<p>This is in contrast to some <a href="https://www.britishsoftdrinks.com/write/MediaUploads/Publications/The_Economic_Impact_of_the_Soft_Drinks_Levy.pdf">industry-sponsored studies</a> that try to make the <a href="https://theconversation.com/case-against-soft-drink-levy-is-sugar-coated-66067">case otherwise</a>.</p>
<p>In Australia, job losses from such a tax are likely to be <a href="https://www.obesityevidencehub.org.au/collections/prevention/arguments-against-an-ssb-tax-in-australia">minimal</a>. The total demand for drinks by Australian manufacturers is unlikely to change substantially because consumers would likely switch from sugary drinks to other product lines, such as bottled water and artificially sweetened drinks. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A tax on sugary drinks is unlikely to cost jobs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-drinking-cola-617854511">Successo images/Shutterstock</a></span>
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</figure>
<p>Despite industry <a href="http://www.acfa.com.au/industry-opposes-amas-sugar-tax-news-mail/">protestations</a>, an Australian tax would have minimal impact on sugar farmers. This is because 80% of our locally grown sugar is <a href="https://grattan.edu.au/report/a-sugary-drinks-tax-recovering-the-community-costs/">exported</a>. Only a small amount of Australian sugar goes to sugary drinks, and the expected 1% drop in demand would be traded elsewhere. </p>
<p><strong>Myth 3: People don’t support health taxes on sugary drinks</strong></p>
<p>There is <a href="https://www.obesityevidencehub.org.au/collections/prevention/the-case-for-a-tax-on-sweetened-sugary-drinks#cite1362">widespread support</a> for a tax on sugary drinks from major health and consumer groups in Australia.</p>
<p>In addition, a national survey conducted in <a href="https://www.ncbi.nlm.nih.gov/pubmed/31248926">2017</a> showed 77% of Australians supported a tax on sugary drinks, if the proceeds were used to fund obesity prevention. </p>
<p><strong>Myth 4: People will just swap to other unhealthy products, so a tax is useless</strong></p>
<p>Taxes, or levies, can be designed to avoid substitution to unhealthy products by covering a broad range of sugary drink options, including soft drinks, energy drinks and sports drinks. </p>
<p>There is also evidence that shows people <a href="https://doi.org/10.3945/jn.117.251892">switch to water</a> in response to sugary drinks taxes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sweet-power-the-politics-of-sugar-sugary-drinks-and-poor-nutrition-in-australia-95873">Sweet power: the politics of sugar, sugary drinks and poor nutrition in Australia</a>
</strong>
</em>
</p>
<hr>
<p><strong>Myth 5: There’s no evidence sugary drink taxes reduce obesity or diabetes</strong></p>
<p>Because of the multiple drivers of obesity, it’s difficult to isolate the impact of a single measure. Indeed, we need a <a href="https://doi.org/10.1017/S1368980018003324">comprehensive policy approach</a> to address the problem. That’s why Dr Muecke is calling for a tax on sugary drinks alongside improved food labelling and marketing regulations. </p>
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<h2>Towards better food policies</h2>
<p>The Morrison government has previously and repeatedly <a href="https://www.news.com.au/national/breaking-news/health-minister-rebuffs-sugar-tax-calls/news-story/fc89cd403d68e6c931ae5edbd78bd18f">rejected</a> pushes for a tax on sugary drinks. </p>
<p>But Australian governments are currently developing a <a href="https://consultations.health.gov.au/population-health-and-sport-division/national-obesity-strategy/">National Obesity Strategy</a>, making it the ideal time to revisit this issue. </p>
<p>We need to stop letting myths get in the way of evidence-backed health policies. Let’s listen to Dr Muecke – he who knows all too well the devastating effects of products packed full of sugar.</p><img src="https://counter.theconversation.com/content/130694/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Sacks receives funding from the National Heart Foundation of Australia, National Health and Medical Research Council and VicHealth. </span></em></p><p class="fine-print"><em><span>Christina Zorbas receives funding from the Australian Government Research Training Program, The Cancer Council Victoria and VicHealth. </span></em></p><p class="fine-print"><em><span>Kathryn Backholer receives funding from the National Heart Foundation of Australia, The Cancer Council Victoria and VicHealth</span></em></p>Myths that taxes on sugary drinks unfairly disadvantage the poor and will result in job losses don’t hold up. Here’s what the evidence says.Gary Sacks, Associate Professor, Deakin UniversityChristina Zorbas, PhD Candidate, Deakin UniversityKathryn Backholer, Senior research fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1272952019-12-02T03:30:34Z2019-12-02T03:30:34ZEliminating food deserts won’t help poorer Americans eat healthier<figure><img src="https://images.theconversation.com/files/304080/original/file-20191127-112499-1tdy0pv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We love junk food. </span> <span class="attribution"><span class="source">Mumemories/Shutterstock.com</span></span></figcaption></figure><p>In the U.S., rich people tend to <a href="https://www.ncbi.nlm.nih.gov/pubmed/18469226">eat a lot healthier</a> than poor people. </p>
<p>Because poor diets cause obesity, <a href="https://doi.org/10.1371/journal.pmed.1002039">Type II diabetes</a> and other diseases, this nutritional inequality contributes to <a href="https://www.cdc.gov/mmwr/volumes/66/wr/mm6650a1.htm">unequal health outcomes</a>. The richest Americans can expect to live <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/">10-15 years longer</a> than the poorest.</p>
<p><a href="https://www.reinvestment.com/initiatives/hffi/">Many think</a> that a <a href="https://www.govtrack.us/congress/bills/116/hr1717">key cause</a> of nutritional inequality is food deserts – or neighborhoods without supermarkets, mostly in low-income areas. <a href="https://obamawhitehouse.archives.gov/blog/2011/10/25/first-lady-michelle-obama-making-difference-cities-food-deserts">The narrative</a> is that folks who live in food deserts are forced to shop at local convenience stores, where it’s hard to find healthy groceries. If we could just get a supermarket to open in those neighborhoods, the thinking goes, then people would be able to eat healthy.</p>
<p>The data tell a strikingly different story. </p>
<h2>Negligible change</h2>
<p>We <a href="https://doi.org/10.1093/qje/qjz015">recently studied</a> the impact of opening supermarkets in food deserts in research conducted with fellow economists <a href="https://www.gsb.stanford.edu/faculty-research/faculty/rebecca-diamond">Rebecca Diamond</a>, <a href="http://jessiehandbury.com/">Jessie Handbury</a> and <a href="https://advanced.jhu.edu/about-us/faculty/ilya-rahkovsky-phd/">Ilya Rahkovsky</a>. </p>
<p>From 2004 to 2016, over 1,000 supermarkets opened in neighborhoods around the country that previously had been food deserts. We analyzed the grocery purchases of a sample of 10,000 households living in those neighborhoods. </p>
<p>Did they start to buy healthier food after the supermarket opened nearby?</p>
<p>Although many people began shopping at the new local supermarket after it opened, they generally didn’t buy healthier food. We can statistically conclude that the effect on healthy eating from opening new supermarkets was negligible at best. We calculated that local access to supermarkets explains no more than about 1.5% of the difference in healthy eating between low- and high-income households.</p>
<p>How could this be? </p>
<h2>Why food deserts aren’t the problem</h2>
<p>The food desert narrative suggests the lack of supply of healthy foods is what causes reduced demand for them.</p>
<p>But in the modern economy, stores have become amazingly good at selling us exactly the kinds of things we want to buy. Our research suggests the opposite narrative: Lower demand for healthy food is what causes the lack of supply.</p>
<p>Furthermore, local neighborhood conditions don’t matter much, since we regularly venture outside our neighborhoods. We <a href="https://doi.org/10.1093/qje/qjz015">calculate</a> that the average American travels 5.2 miles to shop. Low-income households aren’t that different: They travel 4.8 miles. </p>
<p>Given that we’re willing to travel that far, we tend to shop in supermarkets even if there isn’t one down the street. We found that even people who live in ZIP codes without a supermarket still buy 85% of their groceries from supermarkets.</p>
<h2>Tax sugar, subsidize produce</h2>
<p>In other words, people don’t suddenly go from shopping at an unhealthy convenience store to shopping at the new, healthy supermarket. In reality, people go from shopping at a faraway supermarket to shopping at a new supermarket that offers the same types of groceries.</p>
<p>To be clear, new grocery stores do provide many benefits. In many neighborhoods, new retail can bring jobs, a place to see neighbors and a <a href="https://buildhealthyplaces.org/whats-new/three-takeaways-for-the-field-grocery-stores-as-community-development/">sense of revitalization</a>. People who live nearby get more options and don’t have to travel as far to shop. </p>
<p>But the data show that healthier eating is not one of those benefits.</p>
<p>Instead, we would recommend tweaking prices as a better approach to encouraging healthier habits. <a href="https://www.nber.org/papers/w25842">Taxes on sugary drinks</a> can discourage their consumption, while food-stamp programs could be <a href="https://www.fns.usda.gov/snap/hip/final-evaluation-report">modified</a> to make fruits and vegetables cheaper.</p>
<p>And, given that <a href="http://doi.org/10.1257/aer.20140297">we develop</a> <a href="http://www.stefanhut.com/uploads/1/1/8/0/118029557/paper.pdf">long-term eating habits</a> as children, parents and <a href="https://www.publichealthlawcenter.org/topics/healthy-eating/food-schools">schools</a> can encourage kids to eat healthier. </p>
<p>Health inequality is one of our society’s most important problems. We hope that this research can direct efforts toward ideas that can materially improve health – and away from ideas that do not.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/127295/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research received funding from the Chicago Booth Initiative on Global Markets, the Wharton Social Impact Initiative, the Research Sponsors' Program of the Wharton Zell-Lurie Real Estate Center, and the USDA Economic Research Service. </span></em></p><p class="fine-print"><em><span>Hunt Alcott, Jean-Pierre Dubé and Molly Schnell have no other disclosures. </span></em></p><p class="fine-print"><em><span> </span></em></p>Many argue the key to helping low-income Americans eat healthier is eliminating food deserts. A new study suggests this doesn’t help.Hunt Allcott, Associate Professor of Economics, New York UniversityJean-Pierre Dubé, Sigmund E. Edelstone Professor of Marketing, University of ChicagoMolly Schnell, Assistant Professor of Economics, Northwestern UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1254212019-10-31T14:45:36Z2019-10-31T14:45:36ZHow business misrepresented evidence: the South African sugar tax story<figure><img src="https://images.theconversation.com/files/298110/original/file-20191022-28120-18f8v22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Corporations misused evidence to manipulate health policy.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In a <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5">recently published study</a> on the political activities of the soft drinks industry in the lead up to <a href="https://theconversation.com/south-africas-sugar-tax-a-bold-move-and-the-right-thing-to-do-72010">South Africa introducing a sugar tax</a>, we outlined the complex and systematic way in which big corporations and business associations misrepresented evidence to the country’s National Treasury.</p>
<p>The issue of evidence being cited by representatives from companies has become increasingly important. This is because of the growth of public consultations to collate evidence before new laws are passed. </p>
<p>We examined a selection of submissions that big companies made to South Africa’s National Treasury during a consultation process on the country’s proposed new tax on sugar. Chief among these were Coca-Cola South Africa, the largest soft drinks manufacturer in the country, the Beverage Association of South Africa, the business association for the soft drinks sector in South Africa, and the American Chamber of Commerce in South Africa, a collective voice of US transnational corporations in South Africa. </p>
<p>Our analysis showed that the evidence cited by the three organisations was either not evidence at all, or had been twisted to suit the industry’s narrative.</p>
<h2>The analysis</h2>
<p>Our analysis built on <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001629">a method used to evaluate evidence use by tobacco companies</a>. There are several components to the method.
The most important centres on something called backward-mapping. This involves comparing evidence presented in submissions with supporting sources and examining how they have been used. </p>
<p>To the casual reader, most of the claims that the industry made would have looked credible. They were often supported by references to peer-reviewed journals, data produced by respected organisations, such as the United Nations’ Food and Agriculture Organisation, and sophisticated-looking economic impact studies which had been commissioned by the industry. </p>
<p>By using the backward-mapping technique we were able to show that the evidence provided didn’t stand up to scrutiny.</p>
<p>For example, we found that in some cases industry representatives simply made things up. The American Chamber of Commerce in South Africa cited a 2013 report by Oxford Economics to support the claim that the impact of sugar sweetened beverages “on health outcomes is uncertain and unproven”.</p>
<p>But we found that the report didn’t in fact examine the relationship between sugar sweetened beverages and health.</p>
<p>Coca-Cola and the Beverage Association of South Africa also used what’s referred to as the “<a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5/tables/1">tweezers method</a>” to get their case across. This involved changing the intended meaning of original text in peer reviewed journals by picking phrases out of context. </p>
<p>For example, Coca-Cola reported that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592517/">a review by two researchers from Harvard School of Public Health</a> had</p>
<blockquote>
<p>concluded that there is limited evidence that consumers do not reduce their calorie intake to offset calories consumed in liquid form. </p>
</blockquote>
<p>These comments were aimed at refuting the idea that someone’s overall daily energy intake was likely to go down if they lowered their intake of sugary drinks. The inference was that the research had found some evidence that people eat more to compensate for reduced sugary drink intake. </p>
<p>In fact the Harvard review had used “limited evidence” to highlight the dearth of studies on the issue. Moreover, the review had indicated that existing findings indicated that intake of sugary drinks may not suppress intake of solid foods to the level needed to maintain energy balance.</p>
<p>Another method we identified was <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5/tables/1">“data dredging”</a>.</p>
<p>Coca-Cola and the Beverage Association of South Africa drew heavily on <a href="http://www.fao.org/faostat/en/#data/FBS">Food Balance Sheets</a> produced by the Food and Agriculture Organisation to argue that sugar wasn’t responsible for the rise in obesity in South Africa. They argued that sugar consumption had declined over time in contrast to the consumption of vegetable oils and cereals which they claimed accounted for the rise in average daily energy intake among South Africans. According to them, this was the biggest cause of obesity.</p>
<p>But they’d specifically selected a time period (1991-2011) that would illustrate this. They used Food and Agriculture Organisation balance sheets for 1991 as the starting point – a year in which the highest per capita daily supply of sugar was recorded over 25 years. In fact <a href="http://www.fao.org/faostat/en/#data/FBS">sugar consumption has risen</a> – and vegetable oils and cereals have fallen – in both the 10 and 20-year period prior to the most recent reported figures (2013).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">Sugary drinks tax is working – now it's time to target cakes, biscuits and snacks</a>
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</em>
</p>
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<p>We also uncovered creative accounting.</p>
<p>The soft drinks industry had commissioned the British-based research consultancy, <a href="https://www.oxfordeconomics.com/">Oxford Economics</a> to model the potential impact of the tax on employment, tax revenue, and gross domestic product. Oxford Economics reported that the tax could lead to between 60,600 and 70,700 job losses. In their submission the beverage association and Coca-Cola pushed these numbers up to between 62,000 and 72,000.</p>
<p>Other aspects of Oxford Economics’ estimates raised questions too. It claimed that a <a href="https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0105287">key study</a> that underpinned their estimates had reported that, “drinkers of sugar-sweetened beverages (were) unlikely to switch to bottled water” and that</p>
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<p>other studies (had) not found statistically robust evidence that people switch from sugar-sweetened beverages to water when the price of sugar-sweetened beverages increase. </p>
</blockquote>
<p>In fact, the study had made no explicit reference to bottled water, but had in fact observed that</p>
<blockquote>
<p>other studies have shown that the demand for tea and coffee, as well as water goes up with sugar sweetened beverages price increases. </p>
</blockquote>
<h2>Vigilance needed</h2>
<p>The above examples represent a small selection of the techniques we identified. Taken in isolation they may not seem that serious. However, the key to understanding the problem is to consider them together, as an alternate system of <a href="https://www.researchgate.net/publication/37702656_Agnotology_The_Making_and_Unmaking_of_Ignoranceg_of_Ignorance">“agnotological”</a> reasoning, which deliberately aims to produce ignorance and doubt about scientific evidence.</p>
<p>Our work highlights the degraded nature of business evidence and underlines the need to rethink the elevated position sometimes given to big corporations’ views in public health policy conflicts.</p><img src="https://counter.theconversation.com/content/125421/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Fooks is a member of the UK Labour Party. He has previously received grant funding from CRUK and Healthway and has worked on projects funded by the US National Institutes of Health. He is currently in receipt of grant funding from the Wellcome Trust.</span></em></p><p class="fine-print"><em><span>Gary Sacks receives funding from the National Heart Foundation of Australia, the Australian National Health and Medical Research Counil (NHMRC), the World Health Organization and the Victorian Health Promotion Foundation (VicHealth).</span></em></p><p class="fine-print"><em><span>Simon Williams has worked on projects funded by the US National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Graham Box 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>We found that evidence cited by three organisations - a big corporate and two industry lobby groups - was either not evidence at all, or had been twisted to suit the industry’s narrative.Gary Fooks, Reader in Sociology and Public Policy, Aston UniversityGary Sacks, Associate Professor, Deakin UniversityGraham Box, Sessional lecturer, University of ReadingSimon Williams, Lecturer in Sociology, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1243252019-10-01T11:36:51Z2019-10-01T11:36:51ZSugary drinks tax is working – now it’s time to target cakes, biscuits and snacks<figure><img src="https://images.theconversation.com/files/294837/original/file-20190930-194866-1uisnqu.jpg?ixlib=rb-1.1.0&rect=0%2C420%2C3215%2C1749&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/shah-alam-malaysia-12-august-2019-1495389632?src=z5QWbvkxRSgdZM2GIvU4Hw-1-36">shutterstock/Zety Akhzar</a></span></figcaption></figure><p>A sugar tax on soft drinks has now been in operation in the UK for more than a year and <a href="https://www.gov.uk/government/news/new-report-shows-further-sugar-reduction-progress-by-food-industry-1">results so far</a> seem to indicate it’s working. But campaigners say more still needs to be done and that the next target should be <a href="https://bakeryinfo.co.uk/news/fullstory.php/aid/21808/Study_adds_weight_to__sugar_tax__on_cake_and_biscuits.html">biscuits, cakes and snacks</a> –- many of which contain high amounts of sugar.</p>
<p>Such taxes have been implemented <a href="https://www.wcrf.org/int/policy/our-publications/lessons-implementing-sugar-sweetened-beverage-tax">in 28 countries and 12 cities as of 2019</a>. Initial results suggest such taxes have the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12868">potential to reduce consumption of sugar</a> and so may help to reduce <a href="https://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf;jsessionid=08FDDAF12DA8F933992B0516CCFC6151?sequence=1">obesity, diabetes and dental decay</a> in the future. </p>
<p>The number of people living with obesity has almost <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32129-3/fulltext">tripled over the past 40 years</a> – and continues to rise. Obesity is increasing most rapidly in <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-031816-044604">low- and middle-income communities</a>. And this is leading to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/26448573">dual burden of malnutrition and obseity</a>, when a population has both too much food and not enough of the right foods.</p>
<p>Excess sugar consumption has been linked with increases in obesity and, as a result, the World Health Organisation recommends that people should consume less sugar. Sugary drinks, such as carbonated soft drinks, sports drinks and <a href="https://theconversation.com/young-people-in-the-uk-drink-more-energy-drinks-than-those-in-any-other-countries-in-europe-93028">energy drinks</a>, are one of the major sources of dietary sugar, especially for children and adolescents. So they have become a key target for sugar reduction – but more still needs to be done.</p>
<h2>The UK picture</h2>
<p>In 2018, the UK became one of the latest countries to implement a tax on sugary drinks. But unlike most other taxes that <a href="https://www2.illinois.gov/rev/questionsandanswers/pages/252.aspx">simply increase the price of products</a>, the <a href="https://www.gov.uk/government/news/soft-drinks-industry-levy-comes-into-effect">UK Soft Drink Industry Levy</a> works by encouraging soft drink manufacturers to reformulate and reduce the sugar content of their products. This means that consumers do not have to change their purchase habits to benefit from reduced sugar consumption.</p>
<p>These taxes can also make revenue that can be used to fund public health programmes such as physical activity in schools or tooth brushing interventions.</p>
<p>A recently published <a href="https://www.gov.uk/government/news/new-report-shows-further-sugar-reduction-progress-by-food-industry-1">Public Health England report</a> highlighted how the UK levy has indeed resulted in reductions in the sugar content of sugary drinks – a 29% reduction per 100ml in retailer own-brand and manufacturer-branded products. And it has also pushed consumers towards low or zero sugar products.</p>
<p>But, that said, the sugar content of non-taxed drinks such as <a href="https://www.theguardian.com/society/2018/nov/13/milkshakes-freakshakes-targeted-by-sugar-campaigners">milkshakes</a> and non-taxed sweet snacks such as biscuits and cakes <a href="https://www.newfoodmagazine.com/news/72340/variation-sugar-calories/">remains high</a>. Indeed, a team of researchers at Queen Mary University of London found that <a href="http://www.actiononsugar.org/news-centre/surveys/2018/2018/new-bmj-open-study-reveals-wide-variation-in-sugar-and-calories-in-cakes-and-biscuits-as-industry-is-accused-of-not-complying.html">97% of cakes and 74% of biscuits</a> contain unnecessary amounts of sugar. This means that the consumption of sugar (at least in England) <a href="https://www.theguardian.com/society/2019/sep/20/britons-consuming-more-sugar-despite-tax-and-anti-obesity-drive">is still a major problem</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/294839/original/file-20190930-194876-1112zff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/294839/original/file-20190930-194876-1112zff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/294839/original/file-20190930-194876-1112zff.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/294839/original/file-20190930-194876-1112zff.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/294839/original/file-20190930-194876-1112zff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/294839/original/file-20190930-194876-1112zff.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/294839/original/file-20190930-194876-1112zff.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">They might look tempting, but there tends to be a wide variation in sugar content in cakes and biscuits.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-cakes-on-shopwindow-supermarket-651197608?src=ecG6O30-1v9TxZ9Y1DR_-w-1-23">Shutterstock/Kristina Kokhanova</a></span>
</figcaption>
</figure>
<p>This is despite <a href="https://www.sustainweb.org/news/sep19_sugarreduction19/">voluntary sugar reduction initiatives</a> that were implemented to encourage manufacturers of sweet drinks and snack products to reduce sugar content by 20% by 2020. These initiatives have resulted in <a href="https://www.newfoodmagazine.com/news/72340/variation-sugar-calories/">a reduction of sugar in some products</a> (showing that it is possible) but almost no change in others, highlighting the limitations of voluntary industry self regulation.</p>
<h2>Snack taxes</h2>
<p>Sugary drink taxes have the potential to reduce sugar consumption. And in the longer term, especially if combined with “snack taxes”, may also help to reduce obesity and diabetes – as supported by <a href="https://www.independent.co.uk/life-style/health-and-families/snack-tax-twenty-per-cent-obesity-soft-drinks-tax-sugar-health-a9092786.html">a recent study published in the British Medical Journal</a>. But there are a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069556/">number of barriers</a> to the implementation of more sugary drink and snack taxes globally.</p>
<p>Opposition from the well resourced and <a href="https://www.theguardian.com/australia-news/2018/jan/10/sugar-tax-why-health-experts-want-it-but-politicians-and-industry-are-resisting">powerful food and drink sector</a>, and associated lobbyists, is a critical barrier. Their arguments against taxation include:</p>
<ul>
<li>Obesity is a condition of individual responsibility, so education and increased physical activity should be encouraged rather than taxation.</li>
<li>Taxation is “regressive” meaning that it affects lower socioeconomic groups more than those in higher socioeconomic groups.</li>
<li>Taxes can result in profit and job losses, negatively impacting the economy.</li>
</ul>
<p>These arguments, which are targeted both at the government and the public, are similar to those used by the <a href="https://www.tobaccotactics.org/index.php/Tobacco_Industry_Arguments_Against_Taxation">tobacco industry against tobacco taxation</a>. And these arguments are pushed directly at meetings with policy makers and indirectly via the media. </p>
<p>Industry groups also argue against taxation <a href="https://www.nytimes.com/2019/09/16/health/ilsi-food-policy-india-brazil-china.html?rref=collection%2Ftimestopic%2FSugar&action=click&contentCollection=timestopics&region=stream&module=stream_unit&version=latest&contentPlacement=2&pgtype=collection">and have influenced food policy globally</a>, for example by funding and conducting research used to support or oppose health policies, or by becoming members of nutrition research panels that advice policy makers. </p>
<h2>Reducing obesity</h2>
<p>But on top of taxes, <a href="https://www.wcrf.org/sites/default/files/Curbing-Global-Sugar-Consumption.pdf">governments do have other options</a>. Actions such as better labelling and the restriction of junk food advertising can make a difference. But it is not just governments who should be responsible for reducing sugar consumption.
<a href="http://www.emro.who.int/noncommunicable-diseases/publications/questions-and-answers-on-reducing-sugar-consumption-to-prevent-and-control-noncommunicable-diseases.html">Everyone has a role to play</a>, including the private sector and wider society. </p>
<p>Retailers, for example, could reduce the promotion of high sugar products in favour of healthier alternatives. And schools or community centres could increase the provision of quality nutrition education. Ultimately, this is a societal problem and so it needs a <a href="https://www.wcrf.org/sites/default/files/Curbing-Global-Sugar-Consumption.pdf">societal solution</a>.</p>
<p>And while taxing sugar and sugary drinks is not going to prevent obesity, diabetes and dental decay overnight, these taxes do have the potential to reduce the sugar content of products on the shelves. They can also help to generate revenue and spark conversations that may lead to changes in social norms around sugar, changes that can make a big difference to the health and wellbeing of millions of people.</p><img src="https://counter.theconversation.com/content/124325/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Bridge is affiliated with the World Federation of Public Health Associations. </span></em></p>Sugar taxes may not prevent obesity and associated conditions overnight, but they can be part of the solution.Gemma Bridge, PhD Candidate, Leeds Business School, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1064902019-08-07T02:11:40Z2019-08-07T02:11:40ZTaxing sugary drinks can benefit Indonesia, research suggests<figure><img src="https://images.theconversation.com/files/286303/original/file-20190730-186841-1gzy33p.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C998%2C730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Indonesia, the highest-income group spends about 27 times as much on sugary drinks as the lowest.</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Obesity and diabetes used to be rich world problems. But diets in lower-income countries are shifting. More people are eating more processed foods and foods high in <a href="https://www.nature.com/articles/nrendo.2012.199">salt, sugar and saturated fat</a>. As a result, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60460-8/fulltext">obesity</a>, diabetes, heart disease and stroke are becoming major health concerns in middle-income countries, including Indonesia. </p>
<p>As of 2018, <a href="https://www.thejakartapost.com/news/2018/11/02/national-health-survey-finds-one-in-five-adults-obese.html">35.4% of Indonesians were overweight or obese</a>. Ten years earlier, <a href="https://pdfs.semanticscholar.org/c92b/62c0cb078547ae6b2078d5154a35fd00434e.pdf">over 5% were living with diabetes</a>. Indonesia’s healthcare system lacks the capacity to cope with this escalating chronic disease burden.</p>
<p>The rising burden is linked to Indonesia’s increasing sugar consumption over the last decade, particularly from sugary drinks. </p>
<p>Indonesia is a large and growing market for soft drinks and energy drinks. Demand is growing around 8-10% each year. Total sales are expected to be <a href="https://www.statista.com/outlook/20020000/120/soft-drinks/indonesia">US$12.9 billion</a> in 2019 – that works out to about 39 litres per person.</p>
<p>The Indonesian government has <a href="https://asia.nikkei.com/Spotlight/Asia-Insight/Southeast-Asian-sugar-taxes-Bitter-pills-for-better-health">considered</a> taxing sugary drinks to solve the increasing health problems. A <a href="https://www.bbhub.io/dotorg/sites/2/2019/04/Health-Taxes-to-Save-Lives.pdf">recent study</a> has shown that the tax can be implemented and would be <a href="https://blogs.worldbank.org/governance/taxing-sugar-sweetened-beverages-sweet-deal">economically beneficial</a>.</p>
<p>In our research, published in <a href="https://gh.bmj.com/content/3/6/e000923">BMJ Global Health</a>, we developed a model to estimate how much benefit taxing sugary drinks could bring to Indonesia. </p>
<p>From this model, we find wealthier Indonesians will benefit most from reductions in chronic disease risk, but the whole population will get healthier in the end.</p>
<h2>Benefits</h2>
<p>Our model for Indonesia is based on <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1072">our previous research</a> that shows sugary drink taxes can help slow the growth in obesity and reduce chronic diseases.</p>
<p>The model aims to measure the health benefit if a <a href="https://www.idea.int/data-tools/data/international-dollars">$0.30</a> per litre tax were spread across income groups in Indonesia. </p>
<p>To do this, we looked at people’s responsiveness to price changes, including whether they switch to other drinks that are not taxed. We also looked at potential changes to the energy content in all of the drinks, and impacts on disease patterns in the population. </p>
<p>All of these factors were estimated by income group, from the poorest 20% to richest 20%. </p>
<p>We found that over 25 years the tax paid by the poorest people would be $0.5 billion, and $15.1 billion for the richest. </p>
<p>While it increases the health status of all groups, the health benefits of the tax were mostly in the higher-income groups because they have the highest consumption and are most at risk of chronic diseases. </p>
<p>In Indonesia, the highest-income group spends about 27 times as much on sugary drinks as the lowest. This is because richer people are more able to afford this lifestyle. </p>
<p>Our model shows cases of overweight and obesity would decrease by about 15,000 for the lower-income people, but decrease by 417,000 for the highest. </p>
<p>Similarly, 63,000 cases of diabetes could be averted in the lower-income group and up to 1,487,000 in the highest. Incidences of heart disease and stroke were similarly reduced. </p>
<h2>Other studies</h2>
<p>Our case study on Indonesia produces a result that contrasts with similar research in richer countries. In richer countries, the health benefits are often <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3070">greater for the poorer in society</a>. This is because they generally consume more low-quality food that is high in sugar, fat and salt.</p>
<p>In most studies of the impacts of sugary drink taxation, benefits are highest for those groups that already consumed large quantities of beverages.</p>
<p>Our model in Indonesia fills the gap in research on the effect of a sugary drink tax on income groups in lower-income countries.</p>
<h2>Benefit for all</h2>
<p>The World Health Organisation and the United Nations have made reducing excess sugar consumption <a href="https://www.who.int/nutrition/publications/guidelines/sugars_intake/en/">a key policy target</a>. </p>
<p><a href="https://www.who.int/bulletin/volumes/94/4/16-020416.pdf">Many countries</a> have begun taxing sugary drinks, <a href="https://www.wcrf.org/int/blog/articles/2018/06/sugary-drink-taxes-%E2%80%93-new-normal">including</a> Mexico, Ecuador, Brunei, Vanuatu, the UK, Portugal, India, South Africa, Saudi Arabia, the Philippines, Thailand and Sri Lanka. </p>
<p>It is about time Indonesia followed in their footsteps.</p>
<p>For countries still in the early phase of a shift to diets high in processed foods, like Indonesia, a sugary drink tax may at first benefit the health of wealthier people most. </p>
<p>However, a tax may also slow the adoption of sugary drink consumption across population groups, by offsetting aggressive marketing by the industry that is designed to increase market share. </p>
<p>Indonesia could thus slow the rise in obesity by taxing energy-dense, nutrient-poor foods and beverages such as sugary drinks. </p>
<p>This could reduce the incidence of non-communicable diseases, both directly due to reduced sugar and through their impact on weight. </p>
<p>Given the difficulties Indonesia is facing in treating chronic conditions, this would also be good for its health system. </p>
<p><em>Emily Bourke from The University of Queensland, Australia, contributed to this article</em></p><img src="https://counter.theconversation.com/content/106490/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lennert Veerman has received funding from the Australian National Health and Medical Research Council, the World Bank, the World Health Organisation and ASEAN. He is affiliated with the Public Health Association of Australia.</span></em></p><p class="fine-print"><em><span>Anne Marie Thow receives funding from public research bodies for related research. </span></em></p><p class="fine-print"><em><span>Febi Dwirahmadi tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.</span></em></p>Our research estimates how much benefit taxing sugary drinks could bring to Indonesia.Lennert Veerman, Professor of Public Health, Griffith UniversityAnne Marie Thow, Lecturer in Health Policy, University of SydneyFebi Dwirahmadi, Lecturer in Global Health, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1063992018-11-06T18:17:48Z2018-11-06T18:17:48ZMeat tax: why taxing sausages and bacon could save hundreds of thousands of lives every year<figure><img src="https://images.theconversation.com/files/244105/original/file-20181106-74783-9339q6.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>By now you’ve probably heard that eating too much red and processed meat is bad for you. Not only is it associated with increased rates of coronary <a href="https://www.tandfonline.com/doi/full/10.1080/10408398.2017.1392288">heart disease, stroke</a>, and <a href="https://link.springer.com/article/10.1007%2Fs11883-012-0282-8">type 2 diabetes</a>, but there is also convincing evidence that red and processed meat <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0020456">can cause cancer</a>. </p>
<p>The cancer agency of the <a href="http://www.who.int/features/qa/cancer-red-meat/en/">World Health Organisation</a> (WHO) classifies the consumption of red meat, which includes beef, lamb, and pork, as carcinogenic – or having the potential to cause cancer if eaten in processed form. This includes hot dogs (frankfurters), ham, sausages, corned beef, and beef jerky – as well as canned meat and meat-based preparations and sauces. </p>
<p>The WHO also classifies red meat as probably <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00444-1/fulltext">carcinogenic</a> – even if eaten unprocessed. There is strong mechanistic evidence for an association between eating red meat and colorectal cancer, and there is also evidence of links with pancreatic cancer and prostate cancer.</p>
<p>Given the negative health impacts, there have been calls for certain types of <a href="https://www.newstatesman.com/politics/staggers/2018/09/why-it-s-time-meat-tax">meat to be regulated</a> similar to other carcinogens – such as tobacco or asbestos – or like other foods of public health concern – such as <a href="https://theconversation.com/sugar-tax-what-you-need-to-know-94520">sugary drinks</a>. </p>
<p>Like taxes on other products that can harm health, a health tax on red and processed meat could encourage consumers to make healthier choices. And <a href="https://www.oxfordmartin.ox.ac.uk/news/health-meat-tax">our new research</a>, which looks at the benefits of a health tax on red and processed meat has found that such as tax could prevent more than 220,000 deaths and save over US$40 billion globally in healthcare costs every year.</p>
<h2>A health tax on meat</h2>
<p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204139">In our new study</a>, colleagues from the International Food Policy Research Institute in the US, and the Oxford Martin School and the Nuffield Department of Population Health at the University of Oxford in the UK, analysed the impact of regulating red and processed meat consumption through a health tax on meat. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/244107/original/file-20181106-74783-13a7ucj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244107/original/file-20181106-74783-13a7ucj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244107/original/file-20181106-74783-13a7ucj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244107/original/file-20181106-74783-13a7ucj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244107/original/file-20181106-74783-13a7ucj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244107/original/file-20181106-74783-13a7ucj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244107/original/file-20181106-74783-13a7ucj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s already a tax for sugar, tobacco, and alcohol, so why not sausages?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>We calculated so-called optimal tax levels that would account for the health costs of red and processed meat in close to 150 countries and regions around the world. So although consumers would still have the choice to eat red and processed meat, they would have to contribute to paying for treating the chronic diseases that its consumption is assumed to cause. </p>
<p>For our study, we used estimates of how red meat and processed meat affect the risks of chronic diseases, and how much it costs to treat those. We then calculated the health and economic burden associated with one additional portion of red and processed meat, and based on that, we estimated the health taxes per portion of red and processed meat that would account for those costs. </p>
<h2>High taxes for high consumption</h2>
<p>We estimated that in 2020, there will be 2.4m deaths attributable to red and processed meat consumption globally, as well as US$285 billion in costs related to healthcare. </p>
<p>High-income countries, such as the UK and the US consume about double the global average of red and processed meat. These countries also spend more money treating the associated chronic diseases. Low-income countries consume less than half the global average and also spend less money treating meat-related diseases.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-should-tax-meat-that-contains-antibiotics-75721">Why we should tax meat that contains antibiotics</a>
</strong>
</em>
</p>
<hr>
<p>Because of this difference in health costs, the health taxes would need to differ by region, to factor in the health and economic burden of red and processed meat consumption in a specific region. And as a result, the health taxes we calculated are based on an economically optimal tax that is high in high-income countries and low in low-income countries.</p>
<p>The health taxes on sausages in Germany, and bacon in the US, for example would increase prices by a whopping 160%. Whereas prices for processed meat in China would have to increase by 40%, and those in Ethiopia by less than 1%. Due to its relatively modest healthcare spending the UK is somewhere in the middle with an 80% increase.</p>
<h2>The benefits</h2>
<p>The higher prices on red and processed meat encourage dietary shifts to other, less harmful foods. Our results suggest that if the health taxes were introduced, consumption of processed meat would decline by about two portions per week in high-income countries and by 16% globally.</p>
<p>Lower consumption of red and processed meat would lead to 220,000 less deaths a year from chronic disease – such as coronary heart disease, stroke, cancer, and type 2 diabetes. It could also have positive knock-on <a href="https://www.oxfordmartin.ox.ac.uk/news/201810_Springmann_Nature">effects on climate change</a> and <a href="https://theconversation.com/how-climate-change-will-affect-what-we-eat-in-2050-55604">body weight</a>. </p>
<p>We found that it could reduce global greenhouse gas emissions by over a hundred million tonnes – mainly due to lower beef consumption. And it would also reduce levels of obesity by driving consumers to lower-calorie substitutions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ten-deadly-carcinogens-youve-probably-never-heard-of-49839">Ten deadly carcinogens (you've probably never heard of)</a>
</strong>
</em>
</p>
<hr>
<p>Tax revenues would amount to US$172 billion globally and cover 70% of the health costs that red and processed meat consumption puts on society. To fully cover the costs, the health taxes would have to be doubled and, in high-income countries, increase to 200% for processed meat.</p>
<p>Our findings make it clear that the consumption of red and processed meat has a cost – not just to people’s health and to the planet – but also to healthcare systems and the economy. Governments don’t need to tell people what they can and can’t eat, but they have a responsibility to encourage the adoption of healthy and sustainable diets. And making sure the health costs of foods are reflected in their prices is an important component of that.</p>
<hr>
<p><em>More articles about <a href="https://theconversation.com/uk/topics/veganism-25812?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=Diet">vegetarianism and veganism</a>, written by academic experts:</em></p>
<ul>
<li><p><em><a href="https://theconversation.com/vegan-diet-how-your-body-changes-from-day-one-100413?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=Diet">Vegan diet: how your body changes from day one</a></em></p></li>
<li><p><em><a href="https://theconversation.com/why-arent-more-people-vegetarian-58367?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=Diet">Why aren’t more people vegetarian?</a></em></p></li>
<li><p><em><a href="https://theconversation.com/five-ways-to-encourage-people-to-reduce-their-meat-intake-without-them-even-realising-105762?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=Diet">5 ways to encourage people to reduce their meat intake – without them even realising</a></em></p></li>
</ul>
<p><em>For more evidence-based articles by academics, subscribe to our <a href="https://confirmsubscription.com/h/r/6F561B763B91E4C7?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=Diet">newsletter</a>.</em></p><img src="https://counter.theconversation.com/content/106399/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marco Springmann receives funding from the Wellcome Trust, Our Planet Our Health (Livestock, Environment and People), award number 205212/Z/16/Z.</span></em></p>How a price-hiking “meat tax” could prevent 220,000 deaths and save more than US$40 billion in health care costs around the world every year.Marco Springmann, Senior Researcher, Oxford Martin Programme on the Future of Food, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1010382018-08-12T20:13:44Z2018-08-12T20:13:44ZObesity is a market failure and personal responsibility will not solve it alone<figure><img src="https://images.theconversation.com/files/231021/original/file-20180808-191038-lznzb5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Obesity is rising and so are the costs.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>This is the first of a two-part series on obesity as a market failure. Read the second part <a href="http://theconversation.com/obesity-is-a-market-failure-and-innovation-not-sin-taxes-may-be-the-solution-100970">here</a>.</em></p>
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<p>Obesity levels in Australia and around the world are <a href="https://www.aihw.gov.au/getmedia/172fba28-785e-4a08-ab37-2da3bbae40b8/aihw-phe-216.pdf.aspx?inline=true">high and rising</a>. This comes at an enormous economic cost for society and individuals, not only in terms of <a href="https://www.mja.com.au/journal/2010/192/5/cost-overweight-and-obesity-australia">health care</a> and <a href="https://research-repository.griffith.edu.au/bitstream/handle/10072/373657/NomaguchiPUB3001.pdf?sequence=1&isAllowed=y">productivity</a>, but also in lost quality and duration of life.</p>
<p>Both behavioural economics research and weight-loss trials show that relying solely on Australians to take personal responsibility is doomed to fail, unless governments step in to create environments that promote healthy food and physical activity.</p>
<p>There is plenty of evidence to show obesity is not simply an individual choice. The failure of the unregulated market to deliver societally optimal outcomes calls for government intervention through <a href="http://www.opc.org.au/what-we-do/tipping-the-scales">regulation, taxes and subsidies</a>, to create environments that make the healthy choice the easy choice.</p>
<h2>Notions of ‘rational choices’ are flawed</h2>
<p>An emphasis on the need for “personal responsibility” often comes with a rejection of the need for government action. </p>
<p>In 2004, for example, the then prime minister, John Howard, <a href="http://www.abc.net.au/worldtoday/content/2004/s1142782.htm">rejected a plan to ban fast food advertising during children’s television programs</a>, saying it would “take responsibility away from parents”. </p>
<p>But there are a few requirements for someone to control their weight: </p>
<ol>
<li>they have to want to have a “healthy” weight</li>
<li>they have to know what behaviours influence weight gain and loss</li>
<li>they have to be able to continue with ongoing behaviours that keep their weight in the healthy range.</li>
</ol>
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Read more:
<a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a>
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<p>First, let’s examine that last element – can well-informed individuals who want to lose weight succeed? Some can, and some do. </p>
<p>But I have met obese dietitians, and I don’t think they chose to be as heavy as they were. Some of the world’s top obesity experts are also overweight. Clearly, knowledge alone is not enough to keep a healthy weight. </p>
<p>So, why is it so difficult for many individuals to keep the weight off?</p>
<p>In his book <a href="https://en.wikipedia.org/wiki/Thinking,_Fast_and_Slow">Thinking, Fast and Slow</a>, Nobel prize-winning economist Daniel Kahneman discusses a range of cognitive biases that hinder rational decision-making. </p>
<p>Kahneman argues that most of our daily decisions are made in an instant, without reflection. But experiments also show that contextual cues influence us much more than we realise. </p>
<p>In one study Kahneman cites, participants were asked to estimate how old Gandhi was when he died. They gave a much higher estimate when the previous question was whether he was older or younger than 114 years, compared to if the prompt was 35 years. </p>
<p>Marketing experts also know this – advertising works. In short, the environment in which we live has a large impact on what we eat and how much we move. Our personal choices are bounded choices and not entirely rational.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/taxing-sugary-drinks-would-boost-productivity-not-just-health-79410">Taxing sugary drinks would boost productivity, not just health</a>
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<p>Studies of the long-term success of weight-loss interventions confirm this. </p>
<p>One year after the end of diet and exercise interventions, about <a href="https://www.nature.com/articles/0803015">half of the weight loss has been regained</a>. It seems likely that all weight is back on <a href="http://annals.org/aim/article-abstract/735254/meta-analysis-effect-dietary-counseling-weight-loss">in about 5.5 years</a>. </p>
<p>The participants in such studies are well motivated and excellently informed, and it seems unlikely they changed their minds about wanting to be lean. So, in all likelihood, they were unable to sustain the behaviours required for it.</p>
<h2>Creating a supportive environment</h2>
<p>In 2016 alone, Australia lost an estimated <a href="http://ghdx.healthdata.org/gbd-results-tool">447,839 healthy life years</a> due to high body mass. This is 8.3% of the total burden of disease in Australia.</p>
<p>But this isn’t the cost of personal responsibility. High obesity rates are not the result of a deliberate trade-off, where people choose to accept obesity as an acceptable price for the unhealthy food choices and low physical activity levels they favour. </p>
<p>This is confirmed by the fact that obese people tend to report a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1467-789X.2001.00040.x">lower quality of life</a> than lean people. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-the-government-should-tax-unhealthy-foods-and-subsidise-nutritious-ones-72790">Why the government should tax unhealthy foods and subsidise nutritious ones</a>
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<p>Instead, obesity is a result of environments that lead to these behaviours. Insisting on “personal choice” as a solution will have limited success unless we make it easier to eat more healthily and be more active.</p>
<p>In an environment that stimulates the consumption of unhealthy food and discourages physical activity, many people are unable to stick to the behaviours needed to achieve and maintain a healthy weight. </p>
<p>This means there is scope for the government to get involved and, for example, <a href="https://theconversation.com/why-the-government-should-tax-unhealthy-foods-and-subsidise-nutritious-ones-72790">tax unhealthy foods and subsidise nutritious ones</a>. </p>
<p>Promoting healthy environments would improve overall well-being, the maximisation of which is the proper objective of economics.</p><img src="https://counter.theconversation.com/content/101038/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lennert Veerman receives funding from the National Health and Medical Research Council. </span></em></p>Obesity is not a rational choice. But there is scope for governments to get involved and improve our options.Lennert Veerman, Professor of Public Health, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/958732018-05-02T20:21:16Z2018-05-02T20:21:16ZSweet power: the politics of sugar, sugary drinks and poor nutrition in Australia<figure><img src="https://images.theconversation.com/files/217234/original/file-20180502-153914-ycxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The sugar industry has a lot of influence over health policy.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Unhealthy diets and poor nutrition are leading contributors to Australia’s burden of disease and burgeoning health-care costs. In 1980, just 10% of Australian adults were obese, <a href="https://www.aihw.gov.au/reports-statistics/behaviours-risk-factors/overweight-obesity/overview">today that figure is 28%</a> – among the highest in the world. </p>
<p>And yet, as shown on Monday night’s <a href="http://www.abc.net.au/4corners/tipping-the-scales/9712342">Four Corners’</a> episode – which was a stunning expose of food, nutrition and health politics in Australia – successive governments have done little to address it.</p>
<p>What the program highlighted was as important as what it did not. It showed a clear need for a sugar-sweetened beverage tax and a national strategy with a comprehensive package of measures to reduce obesity. </p>
<p>What we also urgently need (and which wasn’t noted in the program) is a <a href="https://www.phaa.net.au/documents/item/1987">national nutrition policy</a>, based on the Australian Dietary Guidelines, to promote healthy diets and good nutrition more broadly. It is long overdue – we haven’t had one since 1992. </p>
<p>Arguably the most important reason for why none of this currently exists is the gorilla in the policy-making room: the political might of Big Food to undermine support for policy reform. Why does Big Food hold such a powerful grip on Australian food and nutrition policy?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-hidden-sugars-are-pushing-up-your-daily-dose-24417">How 'hidden' sugars are pushing up your daily dose</a>
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<h2>The political power of Big Food</h2>
<p>The Four Corners program is consistent with our <a href="https://www.researchgate.net/publication/312645434_Generating_political_priority_for_regulatory_interventions_targeting_obesity_prevention_An_Australian_case_study">prior research</a> showing that Big Food’s power to obfuscate, delay and undermine food and nutrition policy reform stems from several sources. These include its economic importance as an industry and employer, access to and influence with political decision makers, and the adoption of self-regulatory codes (for instance on marketing and food labelling) as a means to pre-empt, and substitute for, government regulation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fat-nation-the-rise-and-fall-of-obesity-on-the-political-agenda-72875">Fat nation: the rise and fall of obesity on the political agenda</a>
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<p>Many tactics used by these transnational, economic titans sway public policy against what health research shows is the best way forward. Among these are lobbyists disputing the evidence base, companies like Coca-Cola funding research to confuse the science and deflect blame away from dietary intake, and donations by companies to political parties to gain access and influence. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/217236/original/file-20180502-153888-t618px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/217236/original/file-20180502-153888-t618px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217236/original/file-20180502-153888-t618px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217236/original/file-20180502-153888-t618px.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217236/original/file-20180502-153888-t618px.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217236/original/file-20180502-153888-t618px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217236/original/file-20180502-153888-t618px.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217236/original/file-20180502-153888-t618px.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Companies like Coca-Cola have in the past funded research to influence the results.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Four Corners showed Big Sugar’s power also comes through its economic and political importance in the swing “sugar states” of Northern Australia. It came as no surprise to hear from George Christensen – member for one of these states, Dawson – that a sugar tax will impact on the sugar industry (in his electorate) but do “absolutely nothing to impact on obesity”. </p>
<h2>Evidence for a sugar tax</h2>
<p>Geoff Parker, CEO of the Australian Beverages Council, told Four Corners that policymakers have not implemented a sugary drinks tax because they “look to the evidence base”. That such a tax is overly-simplistic – it would be a “silver bullet and white knight” solution to a complex problem. This tactic of disputing the evidence and obfuscating it with claims of complexity is a lobbying classic.</p>
<p>Let’s be clear – comprehensive <a href="https://academic.oup.com/ajcn/article/84/2/274/4649477#110943487">systematic reviews</a> <a href="https://www.bmj.com/content/346/bmj.e7492">clearly demonstrate</a> a link between free dietary sugars, sugary drink consumption and obesity. So much so that in 2015, the <a href="http://apps.who.int/iris/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1">World Health Organisation</a> made a “strong recommendation” to limit free sugars to less than 10% of total energy intake (12 teaspoons per day for the average sized adult). </p>
<p>By far the main source of free sugars in the Australian diet – <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.011">an estimated 81%</a> – comes from energy-dense, nutrient poor “discretionary” (junk foods). <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.011">Over half</a> of free sugars is estimated to come from sugary drinks.</p>
<p>With regards to sugary drinks taxes, the evidence is strong and continues to grow. Such taxes work to drive down consumption, incentivise manufacturers to put less sugar in their products, and generate revenue for investment in public health programs.</p>
<p>An evaluation of Mexico’s sugary drinks tax, for example, demonstrates a <a href="https://www.bmj.com/content/352/bmj.h6704.long">clear reduction</a> in <a href="https://sph.unc.edu/sph-news/sugar-sweetened-beverage-purchases-declined-in-two-years-after-mexican-soda-tax-passed/">sugary drink</a> purchases since the tax was introduced in 2013.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-the-world-can-learn-from-mexicos-tax-on-sugar-sweetened-drinks-56696">What the world can learn from Mexico's tax on sugar-sweetened drinks</a>
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<p>Of course a sugary drinks tax is no silver bullet. It is just one intervention among several that would act synergistically to drive health-promoting changes throughout the food supply and consumer food environment. </p>
<h2>The way forward</h2>
<p>A sugar tax is a good start for tackling the obesity problem. Australia is lagging behind the <a href="http://www.ijhpm.com/article_3431_e907f46cc80d9d0205449cc5e81a6990.pdf">28 jurisdictions with such a tax already in place</a>. But it is only one among many actions needed to prevent obesity. Obesity is in-turn only one among several nutrition problems that will need to be tackled if Australia’s overall disease burden is to be reduced. </p>
<p>Going forward, the most effective and efficient activity to promote good nutrition and prevent diet-related diseases, is a coherent national nutrition policy based on the Australian Dietary Guidelines. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-much-sugar-is-it-ok-to-eat-57345">Health Check: how much sugar is it OK to eat?</a>
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<p>Such a policy will involve governments, nutrition scientists, industry and civil society working together across the food system – from food production through to retail – to promote consumption of five food group foods and the avoidance of discretionary foods. </p>
<p>Big Food should be consulted in relation to policy implementation. But it should not have a seat at the policy-making table nor a role in setting Australia’s food and nutrition policy agenda.</p><img src="https://counter.theconversation.com/content/95873/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phillip Baker receives funding from the World Health Organization. He is an unpaid member of the Independent Expert Group of the Global Nutrition Report and an unpaid Fellow of the Lancet Commission on Obesity. </span></em></p><p class="fine-print"><em><span>Mark Lawrence receives funding from the World Health Organisation and the Australian Research Council, and is a paid board member of Food Standards Australia and New Zealand (FSANZ).</span></em></p>Australia needs a sugar tax, as part of a broader national nutrition policy, to combat the obesity crisis. And the sugar industry is getting in the way.Phillip Baker, Alfred Deakin Post-Doctoral Research Fellow, Institute for Physical Activity and Nutrition, Deakin UniversityMark Lawrence, Professor of Public Health Nutrition, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.