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No sugaring of hard evidence

05 Feb 2016

Dara Gantly on the mounting evidence for the introduction of a sugar tax.

The Commission on Ending Childhood Obesity (ECHO) presented its final report to the WHO Director-General last week (January 25), culminating a two-year process to address the alarming levels of childhood obesity and overweight globally. It is well worth a read (see

The overall ‘take-away’ message from the report is that while no single intervention can halt the rise of the growing obesity epidemic, countries that adopt a ‘whole-of-government’ approach, in which policies across all sectors systematically take health into account, will achieve better outcomes in obesity prevention and treatment. And that ‘whole’ includes the Department of Finance.

Among what it describes as an “integrated package of recommendations”, the Commission believes there is now sufficient rationale to warrant the introduction of an effective tax on sugar-sweetened drink, which would be “the most feasible to implement”, although countries might also want to consider taxes on other unhealthy foods high in fats and sugar.

It seems sugar is indeed the new tobacco — or should that be the new alcohol, given the damage it can cause to our livers. But obesity is also putting our children at risk of developing such conditions as type 2 diabetes, asthma and joint problems.

Certainly the plethora of news, reviews and releases around tobacco cessation that traditional bombard our office in January was replaced this year by a confluence of opinion around whether a ‘sugar tax’ should or should not be adopted.

The Royal College of Paediatrics and Child Health in the UK, in response to Public Health England’s (PHE) innovative Change4Life Sugar Smart campaign, last month (January 4) reiterated its call for the introduction of a 20 per cent tax on drinks high in sugar. Such moves have increased the pressure on British Prime Minister David Cameron to reverse his previously stated opposition to such a sugary drinks tax, to a stance where he is ‘no longer ruling it out’. Given that PHE, England’s Chief Medical Officer, the British Commons select committee on health, and various campaigners have all been pushing for this, it has left Cameron quite a lonely figure.

At home — where 60 per cent of Irish people are overweight, and where the WHO recently predicted we would be the fattest nation in Europe by 2030 — the Minister for Health Dr Leo Varadkar is in favour of putting a levy on sugary drinks, although it would seem Minster for Finance Michael Noonan still needs some convincing, despite his officials reportedly finding that a 25c increase on a litre of soft drink would add about 10c to the cost of a can of premium cola, and would raise an estimated €134 million in additional tax. However, Revenue were opposed to the measure, stating that the tax may cost more to introduce than it would raise and be wide open to evasion, while Food and Drink Industry Ireland has lobbied for avoidance of such ‘discriminatory taxes’ on food and beverages.

So what about all that recent research? Well, a major study in the BMJ last month (BMJ 2016;352:h6704 doi: 10.1136/bmj.h6704) found that in Mexico, a recent 10 per cent tax on sugar-sweetened drinks has been associated with an overall 12 per cent reduction in sales and a 4 per cent increase in purchases of untaxed beverages, one year after implementation.

Pic: Getty Images

Mexico — which has some of the highest levels of diabetes and obesity in the world — implemented an excise tax of 1 peso per litre on sugary beverages from January 1, 2014. A new analysis has found that purchases of taxed beverages decreased by an average of 6 per cent in 2014, but that this became larger over time, reaching a 12 per cent decline by December 2014.

In other words, during 2014 the average urban Mexican purchased 4.2 fewer litres of taxed beverages. In contrast, purchases of untaxed beverages were 4 per cent higher than expected without the tax, mainly driven by an increase in purchases of bottled plain water. And the reduction was greatest among households of low socioeconomic status, averaging a 9 per cent decline during 2014 and reaching a 17 per cent decrease by December 2014 compared with pretax trends.

While this is an observational study and thus no definitive conclusions can be drawn about cause and effect, the narrative is a compelling one: taxes can be an important part of a public health strategy on obesity.

More of a projected study, a report published in The Lancet Diabetes & Endocrinology journal (Lancet Diabetes Endocrinol 2016, Published Online January 6, 2016 S2213-8587(15)00477-5) has suggested that reducing sugar content in sugar-sweetened drinks (including fruit juices) in the UK by 40 per cent over five years, without replacing them with any artificial sweeteners, could prevent 500,000 cases of overweight and 1 million cases of obesity, in turn preventing around 300,000 cases of type 2 diabetes, over two decades.

Endocrinologist Prof Donal O’Shea believes it is inevitable that a sugar tax will be introduced in Ireland after the next election, given the mounting health evidence. Some 20 per cent of the calories consumed by Irish five to 12-year-olds every day now comes from sugar-sweetened drinks or savoury snacks, he said. And as was shockingly pointed out last month by Public Health England, children aged between four and 10 eat about 22kg of sugar every year — that’s the average body weight of a five-year-old!

Those yet to be convinced (Minister Noonan included) often point to the general perception that additional taxes of 20 per cent on sugary or fatty food would be highly regressive since low-income consumers spend a greater proportion of their disposable income on food. Yet other US research recently released (Marketing Science,, looking at sales of full-fat and low-fat milk, found that a modest price difference of just 5 per cent caused a significant shift in market share away from whole milk to lower-fat options.

According to a poll carried out by the Irish Heart Foundation (IHF) last autumn, a majority of people (58%) now support a tax on sugar-sweetened drinks to help reduce childhood obesity. Yes, the public are supportive of a new tax! The survey was carried out to coincide with the Foundation’s pre-Budget submission last September, which also called for a 20 per cent sugar-sweetened drinks tax, with revenue estimated at €44.5 million being earmarked to establish a Children’s Future Health Fund to finance various schemes, such as fruit and vegetable subsidies and community food programmes.

According to the IHF, a health impact assessment for the Department of Health found that a 20 per cent additional tax on sugar-sweetened drinks would reduce obesity by 3 per cent in adults alone — the equivalent of 22,000 people. Such a tax would have an even greater impact if the proceeds were spent on initiatives to tackle obesity.

What are others doing? Well, in effect since January 2012, the French soda tax is an excise duty applied to drinks with added sugar and artificial sweeteners, including sodas, fruit drinks, flavoured waters and ‘light’ drinks. The tax is around 11 cent per 1.5 litres of sugary drink and is used to raise revenue for the general budget.

In Hungary, a ‘public health tax’ adopted in 2012 is applied on the salt, sugar and caffeine content of various categories of ready-to-eat foods, including soft drinks (both sugar- and artificially sweetened), energy drinks and pre-packaged sugar-sweetened products. The tax is applied at varying rates with soft drinks, for example, taxed at 22 cent per litre, and other sweetened products at 43 cent per litre. And more recently, since January 2015, Chile has had an 18 per cent ad valorem tax applied to sugary drinks with sugar content greater than 6.25g of sugar per 100mL.

So we won’t be the first, as we were with the tobacco ban, but we certainly should not be the last to put sugar on the tax menu.

Dara Gantly

Click here to view the full article which appeared in Irish Medical Times: Opinion