Too much sugar is bad for us as both individuals and as a society: long-term overconsumption of sugary foods and beverages leads to higher rates of obesity, diabetes, and heart disease, just to name the most serious health consequences. Those, in turn, radiate through society and show up in everything from investments in pharmaceuticals to levels of health-care spending. That’s a long way of saying that overconsumption of sugar is a public-health problem, and, unsurprisingly, public-health officials are interested in policies that could address it.
This week, Public Health Ontario announced the publication of a new article in the journal PublicHealth Nutrition that looks at whether a tax on sugar-sweetened beverages could reduce people’s consumption. TVO Today speaks with one of the paper’s authors, Brendan Smith, a scientist at PHO specializing in health promotion, chronic disease, and injury prevention, about how such a tax could work — and where the revenues could go.
TVO Today: Why would we want to implement a tax on sugar-sweetened beverages in Canada?
Brendan Smith: Overall, the evidence suggests that consuming too much sugar can be bad for your health. So putting a tax on sugary drinks or making it a little bit more expensive can help Canadians make healthier choices and limit the amount of sugar they consume. And there’s lots of evidence internationally to support the idea that a sugary-drink tax can actually reduce consumption of sugary drinks and therefore sugar.
TVO Today: In your paper, you modelled two different types of taxes — a flat levy of 20 per cent and a tiered tax that increases with higher sugar content. Why look at those two cases?
Scientist Brendan Smith specializes in health promotion, chronic disease, and injury prevention. (Twitter)
Smith: Right now, the World Health Organization is recommending a flat-rate tax of 20 per cent: they call them their best-buy interventions, which are sort of the interventions that they feel are most cost effective and effective for preventing chronic disease. So we modelled that because it’s almost a baseline — if not the gold standard, then the most common tax we would see. Other countries, and particularly high-income countries, have started introducing a tiered tax. And there are potentially a number of different ways in which this is hypothesized or believed to have a bigger impact on reducing sugar intake.
TVO Today: You model the impacts of those two taxes, and you find relatively modest reductions in calorie intake overall: 29 kilocalories per day for the flat tax and 40 for the tiered tax. Would those kind of numbers actually have substantial health impacts for people?
Smith: Anytime we’re looking at a mean, there are definitely some people that will be above that number, and some people will be below. And we calculated that average as a daily number, so it can really add up over time when you’re talking about consuming that much more energy from sugar. Oftentimes with public-health interventions that are focused on a whole population, what seemed like smaller effects can add up to really big health impacts over the population itself.
The other thing is that introducing the tax can impact sugary-drink consumption in a number of ways — a number of which can be more subtle. So, for example, in England and Portugal, when they had similar taxes that they implemented, what they found was that the manufacturers of the sugary drinks actually reduce the amount of sugar in their drinks to follow along with some of the tax limits that were set. So, even then, there can be lower sugar consumption without any change in behaviour whatsoever.
TVO Today: Other papers have argued that a tax on sugary drinks might be too narrow, since they’re only one way that people take in excess sugar in their diet. Other proposals have been to tax all free sugar in processed foods and to subsidize healthier foods like fruits and vegetables. Where do you see this paper informing that debate?
Smith: There’s no one policy that will address all these complex issues related to health, particularly those that lead to chronic disease. There are lots of other suggestions that might go along with this or help and support it: a network of interventions to reduce sugar intake. Those can range from financial incentives like taxes and subsidies to rules around advertising or restricting availability. It’s just one potential policy we might look at to reduce sugar intake in Canada.
TVO Today: The title of the article emphasizes the “equitable impact” of sugary-drink taxes. As a researcher in this field, how do you think about the social context to all this?
Smith: One of the things we found in this study was that the sugary-drink tax could be particularly helpful in limiting consumption in children and adolescents and in males and individuals with lower education, lower income, and higher food insecurity. It could have a bigger impact for those groups, and that’s really important. The second thing is that when you talk about equity related to these taxes, it’s a delicate balance. On the one hand, we know that tax may weigh more heavily on Canadians who spend a larger share of their income on sugary drinks. However, we also know, as public-health practitioners, that a lot of evidence shows they will also have higher or better health benefits.
Ultimately, what the evidence really shows is that it’s really important to consider what we do with the tax revenue generated by a sugary-drink tax. Reinvesting in things like communities that are most impacted by the tax can be really helpful to enhance the equity of a taxation policy like this. In the article, we talk a little bit about some examples from the United States where they’ve actually done this and they’ve invested large amounts in things like early childhood programs and community improvements — including recreational centres and libraries — and also increasing healthy food and beverage access and just being transparent about that upfront. Where the tax revenues from this policy ultimately end up going can have a large impact on how equitable the tax is.
[TVO Today asked Health Minister Sylvia Jones's office whether the government was considering any kind of sugar-sweetened beverage tax. "We are not considering any changes," a spokesperson said via email.]
This interview has been condensed and edited for length and clarity.
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