News and Views
Op Ed: Ireland’s sugar tax is a step in the right direction
The proportion of the population who are overweight and obese has increased markedly over the past three decades in both developed and developing countries.
In Ireland approximately 25% of adults are obese and a further 35% of us are overweight. Between 1990 and 2011 the prevalence of obesity in 18-64 year old Irish adults increased from 8% to 26% in men and from 13% to 21% in women. Similar trends have occurred in children and approximately 25% percent of Irish children are overweight or obese. In work led by the School of Public Health in UCC, we conservatively estimated the costs of overweight and obesity on the island of Ireland in 2009 at €1.6 billion per annum. This includes both direct healthcare costs and indirect societal costs from disability, lost productivity and premature death. It does not include the effects of overweight on psychological well-being, social stigma and quality of life.
While we now have evidence that the rising trends in body weight in children and adults have plateaued in Ireland and in other high-income countries (albeit at high levels), obesity rates have accelerated in many developing countries, driven primarily by the remorseless, global promotion of processed foods high in fat, sugar and salt. Governments around the world, including our own, are therefore struggling to devise strategies that will stem and ultimately reverse this epidemic. This provides the backdrop for the decision by the Minister for Finance to introduce a tax on sugar-sweetened drinks which will take effect from April 2018, alongside a similar tax in the UK and Northern Ireland. Ireland now joins a group of nineteen countries that have introduced taxes on food and drinks with more likely to follow within the next few years.
Globally, we may now be at the start of a long overdue shift from an individual/ personal agency perspective to a societal perspective in food policy actions, a move away from naïve and limited health education strategies towards societal level interventions such as mandatory food reformulation, subsidies, and taxation. The food industry response to these developments is sceptical, to put it mildly. The industry argues that initiatives such as the sugar-sweetened drinks tax in Mexico and a saturated fat tax in Denmark have not resulted in demonstrable improvements in health and have the potential to cause job losses in affected sectors. Fortunately, evidence exists to counter these narratives, including data from Mexico showing that a 10% tax on sugar-sweetened beverages (equivalent to 1 peso (4p) per litre of sugary drink) was associated with a decline in purchases averaging 7.6% over two years with the biggest effect on the poorest households. Denmark’s much-maligned tax on saturated fat didn't survive, but research published soon after it was repealed showed that consumption of saturated fat had declined in Denmark while the levy was in force.
In Ireland, the sugar tax has also attracted controversy with the suggestion from a prominent sceptic that the effects are likely to be trivial as sugar-sweetened drinks do not contribute significantly to calorie intakes in adults. However, this observation on sugar intakes in adults is largely irrelevant as the main focus of the proposed tax is on reducing intakes of sugar-sweetened drinks in children.
In a recent study (the Cork Children’s Lifestyle Study), led by Dr Janas Harrington from the School of Public Health, UCC, we collected detailed health, lifestyle, physical activity and dietary data from over 1,000 school children aged 8-10 years in Cork city and county. We found that the majority (82 percent) of children were consumers of sugar-sweetened drinks, and these drinks contributed an average of 106 kcal, 135 kcal and 292 kcal per day for normal weight, overweight and obese children respectively. These findings are consistent with emerging evidence from a range of studies, including randomised control trials that show reducing intakes of sugar-sweetened drinks decreases the risk of weight gain and obesity in children and young people.
The core issue in these debates is not about the effectiveness or otherwise of taxes on unhealthy foods but the war of ideas on the appropriate role of the state in protecting and promoting the health and well-being of the population. Industry arguments typically fall back on ideas of personal freedom and the alleged excesses of the “nanny state”. There is an unwillingness to accept that major corporations such as those in the food and alcohol sectors target our health-related choices and behaviours with considerably greater resources and effect than governments. The power of the so-called “nanny state” over our health and wellbeing is trivial compared to the “nanny corporate sector” and while we expect the state to respect our freedom and autonomy insofar as possible, the state also has a critical stewardship role in protecting and promoting the health and well-being of the population, especially the health of children and vulnerable adults.
Clearly, the introduction of the sugar tax is not a magic bullet that will resolve the obesity epidemic overnight. It is, however, a potentially significant step forward, especially if combined with other measures at the individual and societal level. In this context, it is important to note the common causal factors and potential solutions that link obesity with climate change, the major public health issue of our time and one that is inextricably linked with the obesity epidemic. Specifically, the promotion of healthy plant-based diets with reduced meat consumption combined with policy measures to promote walking, cycling and public transport will impact directly and rapidly on both carbon emissions and on the population burden of obesity and related chronic disease. There is a potential “win-win” for society in this scenario if we can draw on the collective expertise of the environmental, agri-food and health sectors.
Professor Ivan J Perry, MD, PhD is Professor of Public Health, School of Public Health UCC
For more about the research and courses at the UCC School of Public Health visit here