In considering the introduction of a “sugar tax” in Budget 2016, the challenge for the Government is to balance public interest and public perception, in the context of very effective food-industry lobbying against the initiative. It is a tough call. Certainly, there are reasonable arguments against the introduction of sugar taxes. They would not be popular. What tax is?
They would be arbitrarily defined, but so are many other taxes. They would be regressive, with a disproportionate effect on poorer people and this might paradoxically reduce the affordability and consumption of healthier foods.
Rigorous experimental evidence that sugar taxes influence population health simply doesn’t exist, because such experiments aren’t really possible. However, the absence of evidence isn’t evidence of absence of an effect of sugar taxes on health.
Much of the criticism of sugar taxes comes from vested interests and organisations advocating for the food industry. They argue that no single initiative will deal with the obesity problem and that solutions have to be multifactorial and multi- sectoral. This is analogous to saying that better psychiatric services, not tighter gun controls, are needed to prevent mass shootings.
Food-industry lobbyists say that sugar taxes won’t work. If so, why are they so concerned about their introduction?
Generate funding
From a population-health perspective, if the tax doesn’t reduce consumption it will still generate funding for other strategies. If it works, it will have a direct impact on population health, but with less revenue generation. Either scenario is desirable to those who want to reduce obesity levels, so the discussion around predicted effect sizes is somewhat academic.
Organisations such as the Nutrition and Health Foundation, and the scientists they fund, who say that adverse dietary behaviours aren’t driving obesity couldn’t be more harmful to population health if they had malignant intent.
Of course obesity is multifactorial and no single initiative in isolation will solve the problem. However, the proposed sugar tax is arguably the most significant intervention of all, because it could fund all of the others.
If predictions of more than €130 million being generated are true, and this was hypothecated for health strategies, it would bolster them immensely. We could improve cycling infrastructure, playgrounds, access to healthy foods and educational initiatives.
The Government’s overarching plan for better population health has been outstandingly well articulated in the Healthy Ireland initiative.
For the thousands in whom the obesity “time bomb” has already gone off, we could make our hospital bariatric services fit for purpose. A decade ago, we were able to account for every cent from the plastic-bag tax , and we reinvested this money in environmental initiatives.
We should and can do the same for obesity initiatives from a sugar tax.
Moderate lifestyles
Much recent public discourse has focused on how unfair this tax would be on citizens who lead responsible and moderate lifestyles.
The media portrayal of obese people as reckless gluttonous sloths who lack moral fibre, motivation and insight isn’t just over-simplistic and reductive. It is inaccurate.
The truth is that obesity is a complex neurobehavioural disorder which has strong genetic and environmental influences. This means that some people find it harder than others to eat healthily and to be physically active. We cannot change our genes, so we need to do everything we can to address the environmental determinants of obesity.
As with going after cigarettes rather than smokers and alcohol rather than drinkers, we need to influence the availability of unhealthy foods and drinks that we know for certain cause obesity and diabetes. The introduction of a sugar tax would represent a shift in Government thinking away from going after obese people and instead going after the junk food and drink that is making them fat.
The “Varadkar Doctrine” might recognise that our obesity disaster is as much about societal, political and legislative responsibility as it is about personal responsibility and that for complex reasons, some people find it harder than others to be thin.
It might state that even in the absence of experimental evidence that sugar taxes work, we should implement them on the basis of the precautionary principle that they almost certainly will work and are unlikely to cause harm. It could acknowledge that while there is nothing inherently wrong or dishonourable about producing or selling soft drinks in the same way that there is nothing wrong with selling wine or sports cars, the so-called “negative externalities” associated with these products need to be offset with taxation.
We’d all be delighted if crisps didn’t make you fat and sugar-sweetened beverages didn’t cause diabetes, but unfortunately there is irrefutable evidence now that they do.
Until now, we have been uniquely intolerant and unforgiving of the folly of overeating and the sole reliance on personal responsibility as a solution to the problem has been completely ineffective. In considering whether to adopt a sugar tax in Budget 2016, we should recognise that obesity is as much about the choices we make as a nation as it is about the choices we make as individuals. Dr Francis Finucane is a consultant endocrinologist at Galway University Hospitals. Jacky Jones is away.