The public health field is never short of controversies. On 22nd October 2015, Public Health England (PHE) published a report on Sugar Reduction: The Evidence for Action. The report recommends inter alia, an introduction of a sugar tax of between 10% and 20% on high sugar products such as soft drinks (PHE, 2015b). This has sparked endless debates within the academic and public domains. The vociferous debate sustains when subsequently, the government guarantees that there will be no tax imposition on sugary products, whilst insisting that there are other workable alternatives for tackling health issues, particularly obesity, as a result of overconsumption of products with a large amount of sugar.
Borrowing from the Nudging Theory, tax is seen as a ‘shove’, capable of prevailing the ‘upstream approach’ in public health (policy approach that can affect large populations, such as economic disincentives) through the preventative route (Local Government Association, 2013). This blog post seeks to explore whether the government should reconsider its initial decision not to impose a taxation on sugary products. It will take stock of the evidence that links sugar with obesity, and consider the success of a sugar tax in various countries in addressing the population’s health. It then goes on to explore the power of taxation in changing people’s behaviour and the potential benefit of such a measure on the NHS, before considering whether the tax on sugary products can address the failure of the Public Health Responsibility Deal between the government and the food industry.
Firstly, the evidence linking sugary products and obesity is nearly impossible to ignore. The PHE publication highlights that almost a quarter of all adults, one in ten children aged 4 to 5, and nearly two out of ten children aged 10 to 11 in England are obese, with significant numbers also being overweight. Sugar intakes of all population groups are also above the recommendations. Unsurprisingly, the most disadvantaged sections of society have a higher prevalence of tooth decay and obesity.
One may ask: Will taxation on sugary products ever work? Evidence from Mexico suggests that following a 10% tax, there was a 6% reduction in the sales of sugary drinks (Instituto Nacional de Salud Pública, 2015). Following such a success, our European Union counterparts including Denmark and Hungary were quick to follow suit (European Commission, 2014), with overwhelming support from Ireland (Irish Heart Foundation, 2014). It will therefore be difficult for the government to maintain its initial reluctance to imposing a fiscal restriction on the products with a high sugar content considering the magnitude of obesity in this country, and the initiative of European allies on the economic control of sugary products.
Secondly, the fiscal approach presents us with a powerful opportunity to change people’s behaviour towards their sugar consumption. Scholars talk about the obesogenic environment and its causes, which consists of a tangled web of dietary, lifestyle, environmental, and genetic factors. However, rather than seeing its key role in persuading people to alter their sugar intake, the government reasoned that the tax would raise the cost of living, mediated by the aspiration to increase the productivity and economic growth in the food sector (Petitions – UK Government and Parliament, 2015).
On the surface, the government’s U-turn on the sugar tax is didactic – it should be left to individual choices to make the best decisions with regard to their health, in an attempt to avoid nanny-statism. Nevertheless, this assumption will only work in an ideal world. Some people need support to lead a healthy lifestyle, particularly those who are the most disadvantaged within the society. In this instance, a sugar tax would nudge (or in fact, shove) people into making healthier choices and thus preventing people from having complex health needs at a later stage, in line with the preventative agenda of the government in the health sector.
The annual cost of obesity is now greater than the cost of treating health problems arising from smoking (Scarborough et al., 2011). Perhaps tellingly, the estimated annual cost of obesity to the NHS is approximately £5bn, and is growing (Public Health England, 2015a). The introduction of a tax on sugary products will ensure that the pricing structure of the sugar-related products is more reflective of the external and wider costs of the substance to society and the health system as a whole. As such, it may also create a ripple effect on tackling other non-communicable diseases such as those caused by poor nutrition, physical inactivity, and alcohol dependency.
Thirdly, the tax on sugar will overturn the government’s failure on the Government Public Health Responsibility Deal with the food and drink industry (see Gornall, 2015). The core commitment of the Responsibility Deal is to ‘support and enable people to adopt a healthier diet’. However, the Responsibility Deal seems like a temple built on a faulty foundation; it relies upon the goodwill of the industry to keep their pledges and there are no penalties attached for failure to observe the pledges. Positioning the debate within the mainstream media, the celebrity chef, Jamie Oliver, challenged the Prime Minister to ‘act like a parent’ with food manufacturers, as ‘the industry has to be kept in line’ in tackling the rising obesity problem (House of Commons Select Committee, 2015). Here, there is a window of opportunity whereby the tax will empower the industry to take charge and materialise their promises in tackling the rising obesity epidemic in the UK.
Let us turn back to our initial question. Should the government consider a U-turn on its initial reluctance to impose tax on sugary products? This blog post has argued the affirmative. Clear correlations between sugar and obesity and success stories within and outside of the European Union should prompt the government to reconsider its initial stand. In addition, assistance from the state remains relevant particularly for those who are at a significant health disadvantage, in the name of the preventative agenda. Imposing a tax on sugary products will also reflect the wider costs of obesity on health and the wider environment. At the same time, it has been argued that the imposition of a tax will put the food industry in the driver’s seat to make genuine efforts in combating obesity in this country.
The taxation route is not a panacea, nor should it be viewed in isolation from other initiatives. Future theoretical and critical debates will benefit from further studies on the impact of a sugar tax on health in the short-term and long-term, and the acceptance of the population towards the tax imposition. This, then, will reinforce the value of taxation in addressing the obesity epidemic in this country.
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