http://www.wedgies.com/question/569fde01353a2a0f0039a51e
Nina Modi, Professor of Neonatal Medicine at Imperial College London and President of the Royal College of Paediatrics and Child Health
Many years ago as an 18-year-old, I spent two weeks at the Outward Bound School at Loitokitok in Kenya. My group consisted of five strapping African girls, one rather weedy Indian (me) and our American volunteer leader. We spent a never-to-be-forgotten fortnight, charging around on the plains and the slopes of a then unspoiled Kilimanjaro. As we tearfully said goodbye to each other, our leader presented us with a farewell present, a single Mars bar each. This was a luxury, the rarest of treats. I vividly remember cutting mine into five neat pieces, indulging in one immediately, and carefully wrapping the others to be savoured over the following days.
Why do I inflict this piece of nostalgia on you? To point out that though Mars bars, or fizzy drinks, are not necessary for health and wellbeing, I, along with many others, like them a lot. And like the truffles and foie gras that I also have come to enjoy, they should be expensive and occasional indulgences. This is possibly the most important purpose of a sugar tax: redefining unnecessary products as treats to be had sparingly.
Today bad food and drink are all too often cheap food and drink. Low prices and pervasive advertising have inspired false beliefs (“a Mars a day, helps you work, rest, and play”) and led to sugary, fizzy drinks being consumed routinely. Hiking up the cost would help place these items in the category marked “occasional pleasure” rather than “everyday expectation.” When I was growing up in the tropics, the vendor at the school gates had ripe guavas, small green mangoes dusted with chilli, and sour Victoria plums sprinkled with salt on his barrow. They tasted delicious, were healthy, and we kids could afford them. Good food should be affordable and bad food expensive.
Richard Tiffin, Professor of Applied Economics at the University of Reading
Obesity is a global problem as complex and politically charged as climate change. Yet by sticking to the evidence we have just managed to negotiate an international climate agreement. To tackle obesity, and the horrendous chronic diseases it causes, we must similarly follow the facts.
You are quite right that we should redefine unnecessary snacks, like chocolate bars, as treats. But is tax the best way to do it? I have no problem with the state intervening in somebody’s choices where those choices have a direct impact on someone else’s wellbeing—or even on their own, where the evidence shows that they do not fully understand these impacts. Changing behaviour is difficult, and tax is a blunt instrument.
Studies show that a 20 per cent UK tax on sugary drinks would cut consumption by 15 per cent and the number of obese adults by 180,000, or 1.3 per cent. This may or may not make the tax worth it—but I would argue not. It might seem that making things more expensive makes them appear luxurious, so people will consume them more sparingly, but the evidence does not support this. Marketers routinely make products more desirable by hiking the price, and I doubt their intention is to reduce sales. (Consider the lager once branded as “reassuringly expensive.”) Yet price rises don’t always boost perceived value. Tobacco, fuel and beer are all taxed heavily. Do consumers now consider them luxuries? Of course not. Reducing smoking has taken decades of education, legislation and social change. Still, one Briton in five chooses to smoke.
Changing mindsets is key and individual psychologies are complex things. Our psychological biases can affect decisions which might seem disconnected but actually may compound one another. It is no accident that people who eat badly also tend to smoke, do less exercise and not invest in pensions. This could be explained by a tendency to discount the distant future at a much greater rate than the near future.
For me the evidence is clear. Tax if you wish, but don’t let us delude ourselves that this will lead to a meaningful change in behaviour. We need a better understanding of the motivations that lead to bad choices and evidence of plans that work by appealing to these motivations. The carrot is better than the stick—and the chocolate bar.
If the evidence is not clear, this is in part because the questions haven’t been clearly defined. To say sugar taxes don’t work raises the question: work on what? A sugar tax may not achieve a statistically significant reduction in obesity, but this isn’t really the ideal outcome measure. The focus on excess body weight has come about because it can be measured easily and very closely correlates with poor health.
Reducing the consumption of sugary drinks is good, raising revenue is good—if put to wise use—and protecting children, who are vulnerable to the actions of adults, is not an assault on personal freedom, but a duty of the state. So the arguments against a sugar tax don’t stack up, and certainly to cite job losses, discrimination against the poor, and judgementalism, as some anti-tax commentators have done, is just nonsense.
A sugar tax alone is not the answer, only part of a wider, as yet inadequately defined solution that the world desperately needs. Ultimately this may well involve combinations of regulatory, fiscal, medical, educational and societal measures to stimulate changes in behaviour, alter satiety thresholds and educate taste perceptions. Consumption must not exceed energy expenditure, and healthy living encompasses more than food and drink. But above all, we must focus on prevention, primarily in fetal life, infancy and childhood.
The question remains: would a sugar tax have a big enough impact to justify its introduction? In my view it would not. The data I cited suggests that at least one marker of poor health, obesity, would not change much. But other aspects of health could get worse. In his review on social and health inequalities, Michael Marmot, a professor of epidemiology and public health at University College London, showed that health follows a social gradient: the poorest individuals will die ten years earlier than the richest. He also showed that the poor pay the largest proportion of their income in tax due to the blind tyranny of indirect taxes. I would be extremely cautious about adding to their tax burden. Making the poor poorer might even damage their health.
I agree that it is a government’s duty to protect young children and the most vulnerable. I am no classical libertarian: I believe in justifiable government intervention. Tax is not exactly a zero-sum game, but there are always winners and losers. Jobs might be lost as a result of a sugar tax. This would only be acceptable if the impacts of the tax have countervailing benefits. This isn’t nonsense—it is evidence-based policy making.
Unfortunately, just focusing on a sugar tax diverts attention away from other steps to improve people’s health. The reasons why people choose to accept poor health are complex. Poverty is one, but there are physiological and psychological reasons too. If we can understand these we can encourage people to make better food choices. We could reformulate foods not only to take out unhealthy nutrients but to make healthier options more appealing in both taste and satiety. We could redesign environments—the supermarket, the staff canteen—to encourage healthy choices. Moving sweets away from the checkout is an excellent example. This type of intervention is far less controversial than a tax and therefore more likely to lead to progress.
Let’s take these points in turn. First the suggestion that a tax on sugar- sweetened fizzy drinks would add to the financial “burden on the poor.” Through low prices and advertising the food industry has persuaded vulnerable people that fizzy drinks are an essential part of a daily diet, when they are wholly unnecessary. A price rise should be accompanied by the information that no one needs them; if you don’t buy them you will have more money, not less.
Second, a tax will lead to job losses? This is the self-same argument trotted out by the tobacco industry. Jobs change as societies evolve. Would we encourage heavy smoking in order to create jobs? Of course not; the challenge for the food industries, to which they have thus far failed to rise, is to make their profits and sustain their workforce from healthy products.
Third, a sugar tax is “controversial”? Public Health England estimates 77,000 lives and £15bn in NHS expenditure are likely to be saved over 25 years by reducing the nation’s sugar intake. Let’s talk about “evidence” too. There have been a number of comprehensive, impartial reviews (for example, reports by the World Health Organisation and Public Health England in 2015 and the McKinsey Global Institute in 2014). All concluded that a sugar tax is likely to reduce consumption. It isn’t controversial, just sadly resisted by many.
Obesity may be a complicated issue, but this shouldn’t be an excuse for inaction. We need globally co-ordinated, long-term national programmes using multiple approaches that lead from primary research and evidence generation and synthesis, to implementation of promising interventions and long-term evaluation of effectiveness. Magic bullets don’t exist, but a sugar tax is absolutely part of the solution.
We began by agreeing that we need to change the perception and status of unhealthy food, including fizzy drinks. Since then we have exchanged several hundred words without agreeing on much. But finally we have agreed that we need better evidence on programmes which encompass multiple interventions. In fact, all of the reports that you cite conclude that taxes are only part of the solution.
Regrettably, our dialogue reflects the national debate about how we improve diets. We agree that something must be done, that we need multiple interventions and then we go head-to-head on the intervention about which we probably have most evidence.
You suggested that the range of possible measures could include education. This is a great example of an area where we are beginning to collect evidence. Intervening with children is a good idea. Food consumption is very habitual and establishing good habits early is key. There are some good, evidence-based, ideas emerging as to how schools can encourage healthy eating (take a look at smarterlunchrooms.org). We need to find out how they impact in the longer term and whether are different interventions more appropriate for different people.
So let’s move on from arguing about a sugar tax. Let’s start pushing for that globally co-ordinated programme to gather the evidence on other ways to encourage people to eat more healthily. I also think that it is critical that we carry the food industry with us. Like it or not, they are key to delivering a solution and they differ from the tobacco industry in one important respect: they are agnostic about whether they make money from selling healthy or unhealthy foods.
