Disclaimer: I don't pretend to be an exert of health politics - as substantial as I think the year of undergraduate economics I took was (hint: it wasn't), issues surrounding health policy are quite interesting to me, but often riddled with many opinions, backed by many potential biases, that make it rather difficult to discern the clear benefit of specific policies.
The current issue surrounds the issue of a SanFrancisco soda taxation - if this sound familiar, it's probably because you've heard of the failed efforts in NYC and Richmond, and the continuing efforts in Berkley. For full access on data relating to total sugar-sweetened beverage consumption in the U.S., see here. There's a few perspectives I've been seeing on the issue:
1. Pro-Taxation - The pro-taxation side supports taxation to curb soda and sugar-sweetened beverage consumption, reducing overall caloric consumption. The soda tax money, which is estimated to generate about $31 million dollars annually, could be used to fund nutrition and public health education. Pro-taxation individuals argue that big beverage industry have millions to spend on advertising for their products, which generally lack nutritional value besides calories (besides electrolytes in the case of sports drinks), and public health efforts are slighted by limited research/education initiatives. For some pro-taxation reads, see here (main site for Sax), here, and here. These individuals tend to put a lot of faith in regulatory agencies.
2. Pro-Choice - Many see this issue as violating freedom of choice, and that government has no place in deciding what foods can be taxed or not. I always like to point out that, if you don't like the government influencing what you eat, you're a 950-some page Farm Bill too late on that one. Alas, this is a pervasive opinion. The American Beverage Association heads up a "Americans for Food and Beverage Choice" site known as yourcartyourchoice.com. .
3. Pro-Education - A pretty pervasive perspective I've seen from the RD community (see here for a good summary of the perspective) is that this issue is overly demonizing one set of food products (sugar-sweetened beverages) and blaming them for the prevalence of obesity/Metabolic Syndrome and doesn't acknowledge that sugar can actually be beneficial for things like exercise performance. Many argue that the issue does not need taxing, but requires more nutrition education and the active involvement of healthcare/nutrition professionals in providing education across the lifecycle about healthy lifestyles.
I think it's good to keep in mind that the pro-education and pro-taxation perspectives ultimately have the same goal - a healthier society, with low rates of obesity/metabolic syndrome. The bigger question is - what will be most effective? The pro-taxation side largely relies on other public health efforts, like taxing alcohol and smoking, to show that taxing sodas could reduce soda consumption. Research is pretty mixed on whether this will work and depends upon the kind of assumptions that one makes - in theory, a tax that effectively cut soda consumption by 15% is estimated to have far reaching effects, greatly reducing new cases of diabetes, coronary events, strokes and premature death, while reducing medical costs (1). However, this research often assumes that individuals don't replace soda calories with other foods. A rather timely publication from earlier this year (2), uses NHANES data and early 90's data from soda taxes in Arkansas and Ohio to suggest that soda taxes would do little to affect BMI, and that individuals replace soda calories with other sources. However, this latter study didn't take into account the effects that public health interventions, possible because of the revenue from the tax, could have on educating individuals on health lifestyle choices. One thing the pro-education side doesn't seem to address is who will fund these interventions - it's one thing to advocate for RD's to have major education roles outside the hospital, but it's a sad reality that its hard for RDs to get reimbursed for their services (outside of T2DM/kidney disease), and that hiring them is not the priority of many primary care providers, schools, and other areas for potential intervention.
I've got a couple issues with soda taxes (many related to their ability to curb obesity - see this detailed critical analysis here) but my biggest is that the initiative doesn't appear to be community-based/led. You can tax soda all you want, but without addressing widespread issues of education and availability, individuals, according to (2), will just go buy other low-nutrient/high-calorie products, and the tax will be a bust. I think it's imperative for public health initiatives to be community-driven; feel free to pass it on if you know of it, but I have not seen evidence that officials have gone into the community, identified the reasons people are eating nutritionally inadequate diets, and working with them to address this. A soda-tax seems like an arbitrary shot in the dark - you could tax anything made with added oils and refined grains too, and use similar arguments. A tax incentivizes not consuming soda - but it doesn't fix the bigger issues of availability, education, and motivation. I think it's important also to note that this tax would likely disproportionately burden those in lower socioeconomic statuses. Looking at the way the money has been proposed to be spent - see here - doesn't seem like it will in a community-driven way, and I'm kind of doubtful that it will be effective in the long term. Maybe it's the anthropologist in me but I think we're past the times where public health officials make decisions for communities.
I can see both sides of the tax debate, but also have reservations about them both. Hopefully, you weren't reading this post to get a clear answer - I don't believe that there is one (the answer is going to come down to your political beliefs, and i'm not here to tell you mine). My overall take on the issue is outside of the realm of soda taxes - while I think education would ultimately help, nutrition/health literacy wasn't exponentially higher 80 years ago before the obesity was a major problem. Changing the overall food environment is the issue. We live in a society of abundance, with tons of advertising for a variety of low-nutrition products with targeted organoleptic appeal. In some sense, the obesity issue is a consumer problem, in that the past few generations have demanded cheaper, more convenient food, and have failed to use market pressures to support cheaper, convenient, nutritious food. We've come to a point now where we either wait for market pressures to push for a nutritious food environment (I'm not optimistic, given the many healthwashing movements), or we implement some level of policy to change the food environment (this leads to interesting questions of policy to deter intake of certain food items, or encourage intake of more nutrient dense foods). I can certainly see why some are for the institution of some policy; education seems like an appealing outlet and RDs working alongside the food/beverage industry can push moderate consumption of sugar-sweetened beverages all that they want, but that won't change the fact that companies have no desire to only have moderate consumption of a product - I always wonder, if there was adequate nutrition education, and people sparingly consumed sugar-sweetened soda, would there still be a sugar-sweetened soda industry? E.g. if only the %'age of the population that could actually benefit from sports drinks drank them, would companies have a large enough market to justify producing them - could they keep them cheap enough that people would consider buying them?
I'm not sure whether changing the food environment should be done through policy, or companies needing to adapt to an educated market's demand for nutritious foods - that's the more relevant conversation IMO. I'm hopeful that society is moving in a direction that demands convenient, sustainable, cheap, nutritious food, because the policy process is very slow moving and arguably not effective - that might be a fool's wish. I'm also hopeful that public health can come up with more innovative ways to change the food environment besides simple taxes that demonize one source of empty calories (see Brian Wansink's work).
Other random thoughts about taxes:
1. Those that rely on predictions about calorie reduction not only assume that the calories won't be replaced but also assume that weight loss happens simply by the 3500kcal/lb rule, which it does not (see Kevin Hall's work).
2. I used to think soda taxes were stupid because we already subsidize corn (A Pollan-ite perspective) and we shouldn't tax things we already subsidize, but reading more literature on the issue has illuminated the complex economics of the tax issue, and how changes to current subsidies likely wouldn't affect obesity too much, and actually increase prices of commodities (3,4).
3. Public Health experts desperately need to identify the point of soda taxes - is it to reduce soda consumption or to curb obesity? I saw much rejoicing from a recent survey in Mexico, where soda taxes exist, showing that Mexicans say they're drinking less soda - see here. What the survey didn't say or show was that obesity rates are decreasing, or that people are replacing these calories with more nutrient dense sources of food. I'm not going to start rejoicing until people replace their excessive consumption of soda with more nutrient dense foods. A swap out of soda for cookies is not a public health success.
4. There is this idea in public health that individual policies will only lead to small nudges, and that no one tax will curb obesity. The idea is that many nudges with individual small impacts can have a large impact (i.e. one twig won't build a dam).It's an optimistic take to explain why taxes haven't worked - i'm not sure i'm so optimistic.
It wouldn't be me if I didn't shill for food science a bit and mention that the use of diet soft drinks could play a potentially important role here - companies can still sell diet sodas without the tax. For those with concerns about artificial sweeteners (based on the data, I think safety fears are currently unfounded), there are a number of companies now looking to make naturally sweetened (an arbitrary designation IMO but to each their own) calorie free beverages using sweeteners like monkfruit, stevia and erythritol. I'd like to think these can play an important role in weaning people off of sugar sweetened beverages while also allowing for an indulgence. They're not a fix-all for an unbalanced diet but they sure can play an important role in reducing kcals. Though, I wouldn't mind if we all just stopped creating a demand for plastic bottles...
1. http://www.ncbi.nlm.nih.gov/pubmed/22232111
2.http://onlinelibrary.wiley.com/doi/10.1002/hec.3045/abstract
3. http://giannini.ucop.edu/media/are-update/files/articles/v11n2_1.pdf
4. http://www.sciencedirect.com/science/article/pii/S0306919208000523
The current issue surrounds the issue of a SanFrancisco soda taxation - if this sound familiar, it's probably because you've heard of the failed efforts in NYC and Richmond, and the continuing efforts in Berkley. For full access on data relating to total sugar-sweetened beverage consumption in the U.S., see here. There's a few perspectives I've been seeing on the issue:
1. Pro-Taxation - The pro-taxation side supports taxation to curb soda and sugar-sweetened beverage consumption, reducing overall caloric consumption. The soda tax money, which is estimated to generate about $31 million dollars annually, could be used to fund nutrition and public health education. Pro-taxation individuals argue that big beverage industry have millions to spend on advertising for their products, which generally lack nutritional value besides calories (besides electrolytes in the case of sports drinks), and public health efforts are slighted by limited research/education initiatives. For some pro-taxation reads, see here (main site for Sax), here, and here. These individuals tend to put a lot of faith in regulatory agencies.
2. Pro-Choice - Many see this issue as violating freedom of choice, and that government has no place in deciding what foods can be taxed or not. I always like to point out that, if you don't like the government influencing what you eat, you're a 950-some page Farm Bill too late on that one. Alas, this is a pervasive opinion. The American Beverage Association heads up a "Americans for Food and Beverage Choice" site known as yourcartyourchoice.com. .
3. Pro-Education - A pretty pervasive perspective I've seen from the RD community (see here for a good summary of the perspective) is that this issue is overly demonizing one set of food products (sugar-sweetened beverages) and blaming them for the prevalence of obesity/Metabolic Syndrome and doesn't acknowledge that sugar can actually be beneficial for things like exercise performance. Many argue that the issue does not need taxing, but requires more nutrition education and the active involvement of healthcare/nutrition professionals in providing education across the lifecycle about healthy lifestyles.
I've got a couple issues with soda taxes (many related to their ability to curb obesity - see this detailed critical analysis here) but my biggest is that the initiative doesn't appear to be community-based/led. You can tax soda all you want, but without addressing widespread issues of education and availability, individuals, according to (2), will just go buy other low-nutrient/high-calorie products, and the tax will be a bust. I think it's imperative for public health initiatives to be community-driven; feel free to pass it on if you know of it, but I have not seen evidence that officials have gone into the community, identified the reasons people are eating nutritionally inadequate diets, and working with them to address this. A soda-tax seems like an arbitrary shot in the dark - you could tax anything made with added oils and refined grains too, and use similar arguments. A tax incentivizes not consuming soda - but it doesn't fix the bigger issues of availability, education, and motivation. I think it's important also to note that this tax would likely disproportionately burden those in lower socioeconomic statuses. Looking at the way the money has been proposed to be spent - see here - doesn't seem like it will in a community-driven way, and I'm kind of doubtful that it will be effective in the long term. Maybe it's the anthropologist in me but I think we're past the times where public health officials make decisions for communities.
I can see both sides of the tax debate, but also have reservations about them both. Hopefully, you weren't reading this post to get a clear answer - I don't believe that there is one (the answer is going to come down to your political beliefs, and i'm not here to tell you mine). My overall take on the issue is outside of the realm of soda taxes - while I think education would ultimately help, nutrition/health literacy wasn't exponentially higher 80 years ago before the obesity was a major problem. Changing the overall food environment is the issue. We live in a society of abundance, with tons of advertising for a variety of low-nutrition products with targeted organoleptic appeal. In some sense, the obesity issue is a consumer problem, in that the past few generations have demanded cheaper, more convenient food, and have failed to use market pressures to support cheaper, convenient, nutritious food. We've come to a point now where we either wait for market pressures to push for a nutritious food environment (I'm not optimistic, given the many healthwashing movements), or we implement some level of policy to change the food environment (this leads to interesting questions of policy to deter intake of certain food items, or encourage intake of more nutrient dense foods). I can certainly see why some are for the institution of some policy; education seems like an appealing outlet and RDs working alongside the food/beverage industry can push moderate consumption of sugar-sweetened beverages all that they want, but that won't change the fact that companies have no desire to only have moderate consumption of a product - I always wonder, if there was adequate nutrition education, and people sparingly consumed sugar-sweetened soda, would there still be a sugar-sweetened soda industry? E.g. if only the %'age of the population that could actually benefit from sports drinks drank them, would companies have a large enough market to justify producing them - could they keep them cheap enough that people would consider buying them?
I'm not sure whether changing the food environment should be done through policy, or companies needing to adapt to an educated market's demand for nutritious foods - that's the more relevant conversation IMO. I'm hopeful that society is moving in a direction that demands convenient, sustainable, cheap, nutritious food, because the policy process is very slow moving and arguably not effective - that might be a fool's wish. I'm also hopeful that public health can come up with more innovative ways to change the food environment besides simple taxes that demonize one source of empty calories (see Brian Wansink's work).
Other random thoughts about taxes:
1. Those that rely on predictions about calorie reduction not only assume that the calories won't be replaced but also assume that weight loss happens simply by the 3500kcal/lb rule, which it does not (see Kevin Hall's work).
2. I used to think soda taxes were stupid because we already subsidize corn (A Pollan-ite perspective) and we shouldn't tax things we already subsidize, but reading more literature on the issue has illuminated the complex economics of the tax issue, and how changes to current subsidies likely wouldn't affect obesity too much, and actually increase prices of commodities (3,4).
3. Public Health experts desperately need to identify the point of soda taxes - is it to reduce soda consumption or to curb obesity? I saw much rejoicing from a recent survey in Mexico, where soda taxes exist, showing that Mexicans say they're drinking less soda - see here. What the survey didn't say or show was that obesity rates are decreasing, or that people are replacing these calories with more nutrient dense sources of food. I'm not going to start rejoicing until people replace their excessive consumption of soda with more nutrient dense foods. A swap out of soda for cookies is not a public health success.
4. There is this idea in public health that individual policies will only lead to small nudges, and that no one tax will curb obesity. The idea is that many nudges with individual small impacts can have a large impact (i.e. one twig won't build a dam).It's an optimistic take to explain why taxes haven't worked - i'm not sure i'm so optimistic.
It wouldn't be me if I didn't shill for food science a bit and mention that the use of diet soft drinks could play a potentially important role here - companies can still sell diet sodas without the tax. For those with concerns about artificial sweeteners (based on the data, I think safety fears are currently unfounded), there are a number of companies now looking to make naturally sweetened (an arbitrary designation IMO but to each their own) calorie free beverages using sweeteners like monkfruit, stevia and erythritol. I'd like to think these can play an important role in weaning people off of sugar sweetened beverages while also allowing for an indulgence. They're not a fix-all for an unbalanced diet but they sure can play an important role in reducing kcals. Though, I wouldn't mind if we all just stopped creating a demand for plastic bottles...
1. http://www.ncbi.nlm.nih.gov/pubmed/22232111
2.http://onlinelibrary.wiley.com/doi/10.1002/hec.3045/abstract
3. http://giannini.ucop.edu/media/are-update/files/articles/v11n2_1.pdf
4. http://www.sciencedirect.com/science/article/pii/S0306919208000523
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